complaint·January 25, 2023

The investigation revealed the following: Regarding the allegation… Staff inappropriately completed resident's Physician Report. It’s being alleged the facility is completing sections of the physician report that should be completed by the resident or physician. LPA interviewed 5 out of 54 residents in total. 1 out of 5 confirmed the allegation. R2-5 all state not being aware of the allegation, their physician’s report or a combination of both. R2 states, “I don’t know what a physicians report is and have never seen one so I can’t say.” R4 states, “I’ve never seen that form but why would I need it. I don’t know about the allegation.” R1 states, “they don’t follow the direction of how to fill out the form. When I was given the form, it was not blank. They fill in a lot of things that were supposed to be left blank. I notice the licensee is S2, but it supposed to be the Limited Liability Company (LLC) and not a person.” During interviews with staff, LPA Agard interviewed 3 out of 16 in total. 0 out of 3 were able to confirm the allegation. S1 states, “we usually give R1 a blank form to give to their doctor and bring it back completed.” S2 states, “physician reports we don’t touch. R1 takes it and brings it back.” R3 states, “I complete the top section like height, weight and blood pressure. The back pages are completed by the doctor.” Regarding the allegation: Resident is not notified to participate in care plan. It’s being alleged the facility is not notifying residents about their needs and services plan meetings. 4 out of 5 confirmed the allegation. R2-4 were all unable to confirm they have participated in the collaboration of creating their needs and services plans. R2-4 were all unaware of what the needs and services plan was prior to LPA explaining it and what the plan entails. R1 states, “they haven’t been doing that over the years. They are supposed to do it yearly or if a significant change happened. They haven’t been coming to me and they haven’t been doing the interviews.” During interviews with staff, 2 out of 3 confirm the allegation. “S1 states, R1 never asked to be a part of it.” R3 states, “I complete the LIC 625. It depends on the resident. Some are smart and alert about what I’m asking. Some of them don’t understand or don’t want to talk. It depends on the resident. S1 does the report for R1.” During a record review, LPA Agard observed parts of a physician’s report dated January 2023, that was given to the resident for completion, to be inaccurate or some sections were completed by the facility that should have been completed by the doctor. LPA observed no changes to these sections, but the facility has reported changes to resident’s overall health and ability to ambulate. Thus, making the pre-fill physicians report inaccurate. Based on interviews conducted, LPA observed and interviewed some residents that have the capability of participating in their needs and services plan be completely unaware of the document’s existence or purpose. Residents were not able to confirm having a needs and services meeting annually or as needed. Based on the interviews with staff, residents and a record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated . California Code of Regulations, Title 22 Division (6) and Chapter (8) are being cited on the attached LIC9099-D. An exit interview was conducted, and a hard copy was provided with appeal rights. See LIC 9009-D on the next page