complaint·August 14, 2024

R1 is getting all the additional care that is needed to be provided by the facility when assess by the wellness director yearly. Regarding the increased costs of service, ED has been trying to negotiate a price increase with the reporting party since November of 2023 and the family refuses to accept the increased amount regarding board and care. According to the facility program and record review, ED has been following the 60-day advance notice for a fee increase. Interview sixteen (16) residents out of one hundred seven (107) residents at the facility regarding the above statement are untrue, ten (10) out of sixteen (16) residents expressed no concern regarding this allegation. Based on the information received and record review this allegation is unsubstantiated this time. Allegation #3: The staff did not follow the physician's instructions for prescribed medications. It was alleged that staff did not follow the physician's instructions for prescribed medications. To investigate this investigation, LPA reviewed the Centrally Store Medication Destruction Record (CSMDR) and Medication Administration Record (MAR) of R1. All staff (S1, S2, S3 and, S4) stated that R1 always received their medication as prescribed but resident has a history of refusing their medication and they can’t force the resident to take it. LPA reviewed the Medication Administration Record (MAR) and observed that from February 2023 to July 2023 and from April 2024 to May 2024 the resident medication was given in a timely manner and R1 refused to take their medication occasionally. LPA interviewed sixteen (16) residents about the allegation, and ten (10) out of sixteen (16) residents revealed that it was untrue. Residents stated that they always get their medication as prescribed by their physician and that the staff gives it to them at the correct times. Based on the information received and reviewed this allegation is Unsubstantiated this time. Allegation #4: Staff interfered with the resident's sleeping/bedtime. It was alleged that staff interfered with the resident's sleeping/bedtime. It was alleged that medication was given at an inappropriate time causing R1 circadian rhythm to be interfered. To investigate this allegation, LPA interviewed five (5) out of sixty-five (65) staff and sixteen (16) out of one hundred seven (107) residents. Continue to LIC 9099-C LPA did a record review, and R1 has no medical note from a Primary Care Physician (PCP), sleep specialist, or neurologist to state that medications given at a different time from July of 2023 would cause R1 to have a circadian rhythm. According to interviews with staff, they will only help residents to sleep at night or wake them up at a certain time in the morning when requested to go out with family or doctor appointment. According to interviews with residents, they have no issues with sleeping/ bedtime, residents go to sleep and wake up when they want. Based on the information received this allegation is Unsubstantiated at this time. Allegation #5: Staff isolated resident It was alleged that staff isolated the resident. Staff would leave R1 on their sofa instead of their recliner in bedroom #118. When sitting on the sofa, R1 has a hard time getting up, compared to sitting on the recliner, where R1 can just maneuver from the recliner to their walker to roam the facility independently. To investigate this allegation, LPA reviewed incident reports and interviewed five (5) out of sixty-five (65) staff and sixteen (16) out of one hundred seven (107) residents. LPA found out that R1 needs assistance while walking with their walker and transferring. R1 is at high risk of falling by themselves when transferring and roaming the facility, there are four (4) incident reports: 10.8.2023, 10.21.2023, 11.15.2023, and 2.10.2024 where R1 had fallen. R1 has been advised repeatedly to use the call button for staff assistance for transfer. During the interview ten (10) out of sixteen (16) residents revealed that staff would not isolate them, they have all the freedom to do activities and roam around the facility. Based on the information received this allegation is Unsubstantiated at this time. An exit interview was conducted with Elvis Gutierrez, executive director (ED), and a hard copy of this report was provided. It was alleged that resident #1 (R1) admission agreement addendum M was incomplete and added by the facility. To investigate the allegations above, LPA conducted an initial visit on 5.15.2024. LPA toured the facility and requested and reviewed the physician's report, staff roster, resident roster, admissions agreement of R1, appraisals, and incident reports. LPA interviewed staff and residents, five (5) out of sixty-five (65) staff and sixteen (16) out of one hundred seven (107) residents. The interview with the executive director (ED) and residents regarding the above statement is untrue, and all residents expressed no concern regarding this allegation. Upon reviewing admission agreement records obtained from the reporting party (RP) and records from the facility. According to the ED, no residents can be admitted to the facility without signing all necessary documents. LPA reviewed sixteen (16) other residents' records and all their admission agreements were signed but incomplete on addendum A that has the total cost of monthly fee. All the residents admissions agreement was not filled in appropriately, according to page 13 (addendum A Monthly fee), total costs indicate only the monthly payment, which was incomplete. ED did not indicate additional ‘Monthly Service Agreement Summary Charges (addendum M) as requested on page 13 under ‘additional services’. Therefore, aside from the monthly charges indicated on page 13, ED is then requesting another fee for monthly service fee from addendum M from addendum M. Based on the information and record review received this allegation is substantiated this time. Deficiency will be cited on LIC 9099-D. Exit interview conducted, a copy of this report was given to ED.