Complaint·December 9, 2024

constraints, it was determined that additional investigation was needed to make a finding for the above allegation. Exit interview was conducted with Elizabeth Whittington and a copy of this report was provided. On today's visit, LPA Yee conducted an interview with the Executive Director at 12:01pm, Resident #3 at 1:09pm, Resident #4 at 1:49pm and Resident #5 at 1:57pm. Facility documents were obtained at 1:53pm. Per information obtained through interviews regarding allegation #1 - Due to lack of staff, resident calls are not answered timely, Residents interviewed when the complaint was initially received and on today's visit stated that they do not have any issues getting assistance but know of other residents who are kept waiting for long periods of time from the time they press their pendant to the time staff responds. Per interviews conducted when the complaint was initially filed on 10/18/23, the facility was having staffing issues during the night shift from 10pm - 6am. Staff were not calling in or reporting to work and one staff resigned. Staff scheduled to work from the employment agency were also not reporting to work. The Executive Director at the time that the complaint was files was also not on site often to oversee the operations of the facility and was aware that someone had called off on 10/17/23 and there was no backup coverage. The night shift in Assisted Living normally consists of a Medication Tech and a caregiver and 2 caregivers in Memory Care. As a result of the staff no call, no show on 10/17/23, the Medication Technician had to pitch in as a caregiver on the assisted living side of the facility, on top of their usual responsibilities. There was a total of 3 staff that night including the Medication Technician. Medication Tech did not request assistance from the 2 Memory Care staff as they had their own caseload. Attempts were made to reach the nurse for assistance and she could not be reached by telephone. Per review of the call for service logs, residents calls were not responded to in a timely on the night of 10/17/23 - 10/18/23. The longest response time was 47 minutes to room 406. Per review of the current call for service log from 11/16/24-11/30/24, the longest response time was 44 minutes to room 520 on 11/21/24. Based on the information obtained from interviews and review of facility records, there is sufficient evidence to support the allegation that due to lack of staff on 10/17/23, resident calls are not answered timely, therefore the allegation is substantiated at this time. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview was conducted, Appeals Rights discussed and a copy was given. constraints, it was determined that additional investigation was needed to make a finding for the above allegation. Exit interview was conducted with Elizabeth Whittington and a copy of this report was provided. On today's visit, LPA Yee conducted an interview with the Executive Director at 12:01pm, Resident #3 at 1:09pm, Resident #4 at 1:49pm and Resident #5 at 1:57pm. Facility documents were obtained at 1:53pm. Per interviews conducted regarding Allegation #2 -Facility is not providing a safe environment for the residents, information revealed that two homeless individuals, a male and a female, were observed by a resident wandering around in the common area on the fourth floor of the facility at around 3:30am on 9/25/23. Resident notified staff. The facility is enclosed on all four sides and secured by fences and gates. Visitors enter the facility through the front lobby and are required to check in and out. The front desk is manned 24 hours a day. It is unknown how the 2 individuals entered the premises. It is hypothesized that they either climbed over the fence or that a staff left the gate ajar for re--entry instead of using their keys. The 2 individuals were walked out by staff once they were discovered. Per information received, this was the only incident where the homeless were on the premises. Based on the information received, there is insufficient evidence to support the allegation that the facility is not providing a safe environment for the residents, therefore the allegation is unsubstantiated. Exit interview was conducted and copy of this report provided.