complaint·August 14, 2025

...continued from LIC9099 Allegations: SUBSTANTIATED Staff did not comply with reporting requirements. On 04/02/25 and 08/06/25, LPA requested the Death Report for R7 from S1 and S2. S2 is new to the position and stated he/she would have to research the details. On 03/27/25, LPA advised S1, S2 and S3 of Title 22 reporting requirements. On 08/06/27, S2 confirmed that additional Hospice and Death Reports had not been reported for R3, R4, R5 and R7. Staff did not maintain accurate records for residents. On 04/02/25 and 08/06/25, LPA requested the Death Report for R7 from S1 and S2. S2 is new to the position and stated he/she would have to research the details. The additional Hospice and Death Reports for R3, R4, R5 and R7 were not available or in the files. On 08/06/25, LPA provided S2 with the Unusual Incident Report (LC624) and Death Report (LIC624A) forms to assist with maintaining accurate records for residents’ incidents, hospice, and deaths. On 08/08/25 LPA received R4’s LIC602 that was incorrect with the sex of the resident and not signed by a physician. Licensee did not ensure medications were administered by an appropriately skilled professional. On 04/02/25, 04/21/25, 08/06/25 and 08/07/25, LPA requested the LIC602 and staff training records for those that assisted R1 to confirm and determine R1’s primary condition and medication management requirements. Records dated 04/22/25 revealed that R1’s medication order list for an Insulin Pen-Injector was ordered 02/05/25 and administered by four different staff members throughout April. S2 stated that S3, who’s a registered nurse, normally administers insulin. Due to lack of information (LIC 602 and training records) from S1, LPA was unable to confirm that any of the staff were professionally trained to administer injections. Based on LPA’s interviews and records reviewed, the preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED . Deficiencies are cited from Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections by plan of correction due date, and any repeat violations within a 12-month period may result in civil penalties. Exit interview conducted, appeal rights and a copy of this report provided to Tamika Hill, Manager. ...continued from LIC9099 UNSUBSTANTIATED Licensee did not provide planned activities for residents. On 04/02/25, LPA arrived unannounced and upon arrival LPA observed three (3) – four (4) residents engaged in morning exercises and during departure the residents were present for Music and Memory activities. S2 provided LPA with an activities calendar for April with 1-5 various activities each day of the month. In addition to being the facility’s Manager, S2 was also an activities director and still oversees what is scheduled on the monthly calendar. Staff spoke to residents in an inappropriate manner. R4 was in his/her room and did not respond when asked about the treatment at the facility and if he/she felt everything was okay. R7 is deceased. R5 and R6 have some physical limitations, both have home health aide assistance, are neither stated that the were spoken to inappropriately or heard staff speak to other residents in an inappropriate manner. LPA confirmed that Home Health Aides who are mandated reporters (W1, W2 & W3) never heard or witnessed staff speaking to residents in an inappropriate manner. Licensee retained resident(s) requiring a higher level of care. LPA reviewed Resident (R1, R2, R3, R4, R5, R6) records. On 03/26/25 and 03/28/25, R2’s care notes recorded a swallow assessment and dysphasia management. On 03/12/25, R4’s progress notes states there was wound care (not staged), good and no concerns; on 03/14/25 R4 denied pain and discomfort. On 04/14/25 Hydrofera Blue dressings applied to R6’s leg wound (not staged), and on 04/11/25 the wound was healing without infections. The records reviewed did not reveal that R1, R2, R3, R4, R5, and R6 required a higher level of care. Based on LPA’s interviews, observations, and records reviewed, the allegations are UNSUBSTANTIATED . The finding that the complaint is unsubstantiated means that the allegations are not valid because the preponderance of the evidence standard has not been met. Exit interview conducted, and a copy of this report provided to Tamika Hill, Manager.