complaint·February 3, 2022

...Continued from LIC 9099... The complaint was referred to Community Care Licensing Investigations Branch (IB) and assigned to Investigator Christine Ferris on 05/26/2020. Investigator Ferris conducted interviews with staff, residents and witnesses on 07/14/2020, 07/20/2020, 07/26/2020, and 08/05/2020. Investigator Ferris obtained copies of R1’s medical records from Northridge Hospital Medical Center on 06/24/2020; from Kaiser Permanente Panorama City on 06/18/2020; from Physician’s Preferred Hospice Care on 07/14/2020; from Omni Wound Physicians on 07/29/2020; and Astoria Nursing and Rehabilitation Center on 07/30/2020. On 07/15/2019, R1 was admitted to Astoria Skilled Nursing Facility due to multiple falls and non-compliance with medication regimen and home safety recommendations. R1 lived in own home prior to being admitted and refused to transition out of home or hire caregivers. A report for self-neglect was filed for R1 in January 2019 and again on 07/15/2019. R1 was discharged on 08/19/19 with diagnosis of right heel deep tissue injury and admitted to the Granada Golden Years facility. Information in the Hospice records indicated R1’s start of hospice care was 08/30/2019 and end of care date was 10/04/2019, the day R1 was admitted to the hospital. Hospice nurses provided wound care to R1 every 3 to 4 days. It was also noted that R1’s family were in communication with the hospice agency and aware R1 was receiving hospice services. Information reviewed in the OMNI Wound Physicians report indicated on 09/11/2019, R1 was treated for chronic wound to bilateral posterior heels as R1 was unable to move both lower extremities; left heel, pressure ulcer stage 3-chronic; pressure ulcer stage 4-chronic. A bilateral vascular study of the lower extremity arteries was performed for signs and risk faction of peripheral vascular disease (PVD). The study indicated non-compressible arteries on both extremities. High complexity, treatment course is prolonged due to sustained inflammation vascular factors-immobility. Staging care due to poor wound progression. R1 was seen again on 09/17/2019 where left buttock pressure ulcer stage 3 was added to the diagnoses and treatment plan. R1 was seen again by the wound care nurse on 09/24/2019 and 10/01/2019. ...Continued on LIC 9099C... ...Continued from LIC 9099C... On 10/04/2019, R1 was taken to the Northridge Hospital Medical Center Emergency Room due to R1 was noted to have altered mental status. During the ER visit, R1 was diagnosed with severe sepsis, acute parotitis, acute kidney injury, hypernatremia, and acute encephalopathy secondary to metabolic derangement. On 10/04/2019, R1 was transferred from the ER and admitted to Kaiser Permanente Panorama City for assessment. During the hospital stay, a speech pathology clinical swallow assessment was completed. The assessment results found that R1 demonstrated mild oral dysphagia with reduced mastication and swallow functional for soft foods with no signs of aspiration evidenced. The discharge summary dated 1019/2019, stated R1 was on hospice prior to admission and had a history of stroke, diabetes mellitus type 2, severe malnutrition, chronic kidney disease, and admitted 10/04/2019 for metabolic encephalopathy with severe hypernatremia, dehydration, acute chronic kidney failure, sepsis with MRSA bacteremia likely due to skin/decubitus ulcers and new onset atrial fibrillation. R1 was receiving hospice care during residency at the facility and per the hospice nurse, R1 was properly cared for by facility staff as they adhered to the instructions given to care for R1, communicated well concerning R1’s condition, and there was no concern for neglect or abuse. Per hospice records, R1 was receiving wound care by hospice nurses and OMNI Wound Physicians and R1’s decline was due to R1’s medical condition and not contributed to by facility staff. Based on the information and documentation obtained and reviewed, the Department does not have sufficient evidence to support the allegation of Neglect/Lack of Supervision. Therefore, the above allegation is deemed Unsubstantiated at this time. Also, it was alleged that Resident #1 (R1) was placed on hospice without the consent of the responsible party. Interview with R1’s family member revealed that the facility had mentioned to family member that R1 was on Hospice ‘indirectly’, but they did not know R1 was actually signed up with hospice care. However, interviews with the Physician’s Preferred Hospice Licensed Vocational Nurse (LVN) revealed that they personally called and spoke with R1’s family and explained what hospice entailed, the services provided, the care provided, the explanation of benefits, and the medical equipment. Interviews with hospital personnel also revealed that the primary skilled nurse was receiving phone calls from R1’s family concerning R1’s condition. ...Continued on LIC 9099C... ...Continued from LIC 9099C... Furthermore, interviews with staff revealed that R1’s family had contacted the hospice agency and approved the hospice services. Record review revealed that R1 signed themselves into hospice as they were able to make decisions on their own. Also, on page six of the Physician’s Preferred Hospice, Inc. Comprehensive Nursing Assessment, the narrative and disease trajectory states, “…services by Hospice MSW… were explained and offered to the family and the patient.” Additionally, on the RN Prognosis Summary of the Physician’s Preferred Hospice Care medical records stated, “…the family wishes no further aggressive treatment and has now opted for hospice care for symptoms management and comfort care only…services were discussed in detail with patient’s son and all consents for hospice care were signed.” Based on interviews and record review, the Department does not have sufficient evidence to support the allegation of “resident was placed on hospice without the consent of the responsible party”. Therefore, the allegation is deemed Unsubstantiated at this time. It was further alleged that staff did not ensure Resident #1 (R1) received physical therapy. Interviews with staff revealed that R1 was to receive physical therapy through Kaiser Home Health upon admission to the facility. However, facility staff reported that R1 refused physical therapy shortly after. Additionally, interviews with staff revealed that R1 refused to allow Kaiser Hospital Home Health to touch R1 and the physical therapy discontinued. Furthermore, interviews with staff revealed that R1 was ‘cognitive but non-compliant’. Based on interviews, the Department does not have sufficient evidence to support the allegation of “staff did not ensure resident received physical therapy”. Therefore, the allegation is deemed Unsubstantiated at this time. It was also alleged that staff ordered medical equipment through the resident’s insurance without consent. It was reported that an oxygen machine was ordered for R1 without the approval from R1’s family members. Record review revealed that in the Physician’s Preferred Hospice Care Plan for R1 dated 8/30/2019 to 10/04/2019, the hospice doctor had prescribed under ‘medical equipment’ an A-1 Oxygen machine. Subsequently, through the Hospice Care Plan, the oxygen machine was ordered as it was considered to be necessary for R1’s health. Based on the information and documentation obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “staff ordered medical equipment through the resident’s insurance without consent”. Therefore, the allegation is deemed Unsubstantiated at this time. ...Continued on LIC 9099C... ...Continued from LIC 9099C... Also alleged was facility staff over medicated resident. Review of medical documents revealed that R1’s was admitted to hospice on 8/30/2019 with a primary diagnosis of atherosclerotic heart disease of native coronary artery without angina pectoris and other comorbidities which included but not limited to: shortness of breath, wheezing, depression, anxiety, agitation, generalized body weakness, legal blindness, paralysis due to stroke, and DMII with moderate kidney disease stage three. Due to R1’s medical condition, the Hospice Doctor prescribed nine different medications to be taken by R1 once back at the facility. Interviews with staff revealed that R1 was ‘actively declining’. Also, interview with the Hospice Nurse revealed that there were no concerns regarding staff neglecting or abusing R1 as they would have ‘reported it’. Furthermore, the Hospice Nurse reported that staff was attentive and R1 was well cared for. Based on interviews and record review, the Department does not have sufficient evidence to support the allegation of “facility staff over medicated resident”. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. No citations issued. A copy of this report has been issued. ...Continued from LIC 9099C... The complaint was referred to Community Care Licensing Investigations Branch (IB) and assigned to Investigator Christine Ferris on 05/26/2020. Investigator Ferris conducted interviews with staff, residents and witnesses on 07/14/2020, 07/20/2020, 07/26/2020, and 08/05/2020. Investigator Ferris obtained copies of R1’s medical records from Northridge Hospital Medical Center on 06/24/2020; from Kaiser Permanente Panorama City on 06/18/2020; from Physician’s Preferred Hospice Care on 07/14/2020; from Omni Wound Physicians on 07/29/2020; and Astoria Nursing and Rehabilitation Center on 07/30/2020. On 07/15/2019, R1 was admitted to Astoria Skilled Nursing Facility due to multiple falls and non-compliance with medication regimen and home safety recommendations. R1 lived in own home prior to being admitted and refused to transition out of home or hire caregivers. A report for self-neglect was filed for R1 in January 2019 and again on 07/15/2019. R1 was discharged on 08/19/19 with diagnosis of right heel deep tissue injury and admitted to the Granada Golden Years facility. It was noted that Kaiser Hospital Home Health was scheduled to perform physical therapy but R1 refused and physical therapy was discontinued. R1 was not conserved and made own decisions regarding medical care. Information in the Hospice records indicated R1’s start of hospice care was 08/30/2019 and end of care date was 10/04/2019, the day R1 was admitted to the hospital. Hospice nurses provided wound care to R1 every 3 to 4 days. It was also noted that R1’s family were in communication with the hospice agency and aware R1 was receiving hospice services. R1 was given insulin injections daily by a nurse, either hospice or home health, as noted in the medication log from 09/29/2019 to 10/04/2019. The hospice nurse stated that R1 was properly cared for by facility staff as they adhered to the instructions given to care for R1 and communicated well concerning R1’s condition. Information reviewed in the OMNI Wound Physicians report indicated on 09/11/2019, R1 was treated for chronic wound to bilateral posterior heels as R1 was unable to move both lower extremities; left heel, pressure ulcer stage 3-chronic; pressure ulcer stage 4-chronic. A bilateral vascular study of the lower extremity arteries was performed for signs and risk faction of peripheral vascular disease (PVD). ...Continued on LIC 9099C... ...Continued from LIC 9099C... The study indicated non-compressible arteries on both extremities. High complexity, treatment course is prolonged due to sustained inflammation vascular factors immobility. Staging care due to poor wound progression. R1 was seen again on 09/17/2019 where left buttock pressure ulcer stage 3 was added to the diagnoses and treatment plan. R1 was seen again by the wound care nurse on 09/24/2019 and 10/01/2019. On 10/04/2019, R1 was taken to the Northridge Hospital Medical Center Emergency Room due to R1 was noted to have altered mental status. During the ER visit, R1 was diagnosed with severe sepsis, acute parotitis, acute kidney injury, hypernatremia, and acute encephalopathy secondary to metabolic derangement. On 10/04/2019, R1 was transferred from the ER and admitted to Kaiser Permanente Panorama City for assessment. The discharge summary dated 1019/2019, stated R1 was on hospice prior to admission and had a history of stroke, diabetes mellitus type 2, severe malnutrition, chronic kidney disease, and admitted 10/04/2019 for metabolic encephalopathy with severe hypernatremia, dehydration, acute chronic kidney failure, sepsis with MRSA bacteremia likely due to skin/decubitus ulcers and new onset atrial fibrillation. R1 was receiving constant and consistent medical care through hospice services and OMNI Wound Physicians while residing in the facility. Based on the information obtained, the above allegation is deemed Unfounded at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Exit interview conducted and a copy of this report was reviewed and issued.