complaint·February 10, 2023

On 02/07/2023, LPA Urena conducted a facility folder review in the CCLD Server system to locate the Unusual Incident/Injury Report (LIC 624) pertaining to R1’s hospitalization on 10/23/2020, and to review the section ‘ AGENCIES/INDIVIDUALS NOTIFIED’ . The results were negative, as the LPA after an extensive search, could not locate a report pertaining to the hospitalization of R1, consequently the CCLD office didn't receive an Incident Report. However, LPA Urena did locate a Death Report (LIC 624A) dated 10/29/2020, and submitted by S1 to CCLD via fax; which describes that the Social Worker for the SNF contacted Glen Park at the Valley Village on 10/28/2020, and spoke with the med tech to inform them of the passing of R1, and to request the name of the family's member phone number to notify the family. Additionally, LPA Urena conducted a file review of R1’s documents emailed by the facility to LPA Basili. The record review revealed that the emergency information form (LIC 601) listed the next of kin, and name of nearest relative of R1. On 02/10/2023, at 10:20 a.m., LPA Urena interviewed S1, and requested all LIC’s 624 related to R1 during their stay at the facility. The interview revealed that according to S1's recollection, the family was informed about R1 going to the hospital. Staff was unable to provide file for R1, due to not having a relief staff, and documents not being within reach. Based on the information obtained, and record review, there is sufficient evidence to substantiate the allegation that the facility did not inform the family members, and the CCLD about R1 being hospitalized on 10/23/2020. Therefore, the allegation is deemed Substantiated at this time. The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Citations were issued. Exit interview conducted. A copy of the report and appeal rights were provided. On the allegation that ‘Staff did not return all of the resident's belongings to the family member ’; it is the concern of the complainant that the facility did not return to the family members, R1’s writings, and a recorder when asked (the resident did a lot of writing and had a recorder), and the facility staff only sent the family members an envelope with three letters. To investigate the allegation, LPA Basili interviewed the family members on 10/28/2020 about R1’s belongings. The family members stated that as of the date of the interview, they had not received R1’s belongings (R1’s writings and a recorder), all they received was an envelope. LPA Basili interviewed the administrator on 12/23/2020 and the administrator stated that they believed that the family member received all the belongings that they wanted to keep. The administrator does not recall seeing a box filled writings or a recorder. LPA Urena conducted a file review of R1’s documents emailed by the facility administrator to LPA Basili. The record review revealed that a Client/Resident Personal Property and Valuables Form (LIC 621) was filled out, and signed by R1 on the day of admission to the facility on 10/16/2012. The list of personal items list does not have a recorder as part of the items. Additionally, a Personal Property Inventory form was filled out, and signed by R1 on 02/18/2014. The inventory sheet lists three (3) packs of socks, four (4) regular waist jeans, and three (3) polo shirts. On 02/10/2023, LPA Urena interviewed S1 about R1 belongings, and S1 stated that according to their recollection, the family received all of R1's belongings, but could not specify what belongings. Staff was unable to provide file for R1, due to not having a relief staff, and documents not within reach. Based on the file review, there is insufficient evidence that the writings and a recorder were part of R1’s personal property and valuables. Therefore, the allegation is deemed Unsubstantiated at this time.