complaint·May 7, 2021

Allegation 1: The resident was prescribed inappropriate medications. Based on interviews conducted and document review, resident (R1) was admitted to the facility on 9/25/2018. Resident's medications were prescribed by Kaiser Permanente physician. Resident received home health services via CareMore Touch. On 10/1/2018 CareMore Health stopped Trazadone medication and started Temazepan, Depakote, and Ativan. Medications were changed due to reports by staff and resident (R1's) family that resident had increased agitation and aggression. On 10/3/2018 medication "Trazadone" medication was discharged per CareMore Health notes. Medication discharge note was obtained. Medication side effects were noted by facility staff on 10/5/2018 and Administrator was told by CareMore Nurse Practioner to decrease Depakote, not use Ativan, and monitor the resident until 10/8/2018. Facility followed MD medication orders as directed. Allegation 2: Resident was diagnosed with dehydration and hospitalized. Department of Social Services- Investigation Branch Investigator Douglas Real investigated this allegation. Facility documents and medical records were reviewed. Investigator conducted interviews with staff, CareMore home health Nurse Practitioner, residents, and resident's family members. All staff stated attempts to hydrate and feed R1 were made, but R1 often refused. Administrator contacted CareMore Nurse Practioner and reported change in condition after medication changes. On 10/8/2018, Care More NP arranged for resident (R1) to be transported to a Skilled Nursing Facility (SNF). SNF then transported R1 to PIH Health Hospital Whittier. Resident was admitted with dehydration. Medical records obtained diagnosed resident (R1) with Aspiration Pneumonia. Resident's worsening physical condition at the facility, as well as not eating or drinking sufficiently could have reasonably been caused by R1's advance in Alzheimer's illness. Per CareMore Nurse Practioner no neglect or abuse concerns were noted. The information and evidence obtained did not sufficiently support the allegation. Allegation 3: Staff failed to seek timely medical treatment. The findings indicate that resident moved in to the facility on 9/25/2018. On 10/5/2018 Administrator notified Nurse Practioner (NP) of significant side effects to medication changes. Per NP, staff was instructed to continue administering medication until 10/8/2018. Resident (R1) was receiving Care More Touch home health services by Nurse Practioners. Per Administrator interview, on 10/5/2018 CareMore Nurse Practioner did not think the resident needed immediate medical treatment when R1 began displaying medication side effects, since it is common when there are medication changes. One of the side effects was excessive sleep. Nurse notes did not indicate immediate care was needed on that date. On 10/8/2018, CareMore Nurse Practioner re-evaluated resident (R1), and concluded resident required higher level of care due to illness decline. Nurse Practioner made arrangements to transport R1 to a Skilled Nursing Facility (SNF), because at 2:30 pm resident's " vitals were stable and deemed safe to go to nursing home for IV hydration." Once at Skilled Nursing Facility (SNF) staff stated R1's oxygen saturation dropped to 81%. Resident was transported via 911 to PIH Whittier Hospital where resident was admitted with dehydration and later diagnosed with bilateral pneumonia. SEE NEXT PAGE Allegation 4: Staff failed to report changes of medications to responsible party. Based on interviews conducted with facility staff and CareMore Nurse Practioner the findings reveal that resident (R1's) responsible party was notified of medication changes ordered by R1's doctor. New medications were prescribed in order to treat escalating agitation and aggressive behaviors. Nurse Practioner stated that a non CareMore doctor changed R1's Trazadone medication to Divalproex. It is alleged that responsible party did not authorize medication changes. Per, CareMore home health interview resident's responsible party does not have to authorize medication changes. Administrator stated that multiple texts were exchanged with responsible party regarding medication changes. Allegation 5: Staff failed to provide documentation of the resident's care to the hospital personnel when requested. Administrator stated that on 10/8/2018 CareMore Nurse Practioner arranged transportation to Skilled Nursing Facility (SNF) for the resident. The list of medications were sent with the resident when the transport company picked up the resident. In addition, CareMore case manager sent medication list to SNF as well. Resident (R1) was sent to PIH Whittier Hospital on the same date. Facility Administrator was contacted when resident was hospitalized. Administrator stated that family and hospital was informed that medication list/information was sent with the resident when it was transported to the SNF. It is unknown if SNF facility forwarded the documents to the hospital. There is insufficient evidence to prove that hospital requested the documents from facility staff. Allegation 6: Food service inadequate. Based on staff interviews and a physical plant tour conducted on 10/4/2019, LPA inspected the kitchen, food supply, and residents in care. Sufficient food supply was observed at the time of the visit, and no health and safety issues were observed. Staff interviews revealed resident (R1) was being given fluids, puree diet, Ensure drinks as tolerated, but only ate approximately 50% of the food item given. Staff reported that resident (R1) refused to open its mouth, and ate very little. Staff stated residents are not forced to eat, but they are constantly offered fluids and food whether they are ambulatory or bedridden. Based upon records review, interviews conducted, and observations made the findings indicate that, although the allegation(s) may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. A telephonic exit interview was conducted with Administrator Tiffany Sasada. A hard copy of the report was emailed. Staff was instructed to sign the LIC 9099 reports and return to LPA.