complaint·November 2, 2021

LPA Dulek reviewed a copy of R1's signed Admissions Agreement dated 05/12/2019, including section #9 on Rate Change. This section states that "the cost of providing services by facility to resident is subject to modification upon sixty (60) days notice from facility to resident and/or his/her responsible party, if any..." LPA was also provided a copy of a letter dated 07/27/2020 indicating there will be a rate increase effective October 2020, which provided the resident the required 60 days notice. Interviews revealed the letter was issued to the resident with greater than 60 days notice. Based on interviews and record review, at this time there is insufficient evidence to support the allegation, therefore, the allegation that "admission agreement did not include information on rate changes" is deemed UNSUBSTANTIATED at this time. No deficiencies cited. Exit interview conducted. A copy of the report was provided via email. Regarding the allegation " Resident was not accorded dignity in their relationships with staff: " Interviews revealed that Resident #1 (R1) has care needs that differ from those of the other residents. R1 is non-ambulatory and is particular about how R1's care needs are met. R1 will let facility staff know when R1 is unhappy with the care being provided. According to R1's family member, they understand that R1 can be difficult and is not always kind to the caregivers. Facility staff interviews revealed that R1 yells at them regularly and only wants certain caregivers assisting with R1. R1's needs and service appraisal indicates R1 is "incredibly nasty to caregivers - potential for caregivers to quit." Interviews revealed that facility staff try to be patient with R1 when R1 yells at them, however sometimes caregivers lose their patience with R1. Interviews revealed that staff have raised their voice with R1. Therefore, based on interviews and record review, the allegation that "Resident was not accorded dignity in their relationships with staff" is deemed SUBSTANTIATED at this time. Regarding the allegation "Facility staff do not respond to resident's request for assistance in a timely manner:" LPA reviewed text message documentation provided by R1 indicating there are times when R1 waits for assistance for hours prior to staff entering R1's room to assist them. Interviews revealed that R1 calls for assistance frequently throughout the day and night time. During the night, there is one care staff scheduled for the home and R1 does require 2-person assistance, so when R1 has care needs at night, care staff are unable to respond timely. R1's call pendant wasn't working for some time and R1 was required to call out for assistance. Often times R1 has to call on their cell phone in order to get a caregiver to come assist them. Interviews revealed that residents feel it takes too long for care staff to respond. Therefore, based on interviews and record review, the allegation that "Facility staff do not respond to resident's request for assistance in a timely manner" is deemed SUBSTANTIATED at this time. Regarding the allegation " Facility did not provide basic personal care services to resident:" LPA reviewed R1's needs and service appraisal and physician's report, both of which indicate R1 can feed thyself, but requires assistance with all other ADLs. During the subsequent complaint inspection on 06/10/2021, LPA observed R1's hair to be oily and very tangled/matted in the back. R1 indicated that their hair Report Continued on LIC 9099-C had not been washed in over 6 months. Staff interviews revealed that R1 frequently refuses when facility staff offer to provide care. LPA reviewed documentation for May 2021 indicating the resident refused care 23 days and was out of the facility for 2 days. The remaining 6 days, there is no documentation of refusal. No documentation provided indicated that the physician was notified when R1 refused care or that additional measures were taken to ensure R1's personal care needs were met in spite of the resident's refusal. Therefore, based on observation and interview, the allegation that "facility did not provide basic care services to the resident" is deemed SUBSTANTIATED at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted, todays reports, and appeal rights were reviewed and emailed to the Licensee/Administrator.