complaint·July 12, 2022

Allegation: Staff did not seek timely emergency medical services for resident. During this investigation, LPA reviewed resident files. Per file review, 911 was called due to R-6 choking. Per documentation reviewed, R-6 was choking during mealtime, staff performed CPR and Heimlich Maneuver and 911 was called for assistance. R-6 was taken to the local hospital and was treated. Staff interviews also revealed that staff did seek emergency medical services for R-6. R-6 was unable to be interviewed as R-6 moved out from this facility. Staff interviews and file review does not corroborate this allegation. Allegation: Staff prevent resident from making and receiving phone calls. During this investigation, facility tours (virtual and in person) were conducted, Resident #1 through Resident #6 (R-1 through R-6) files were reviewed and relevant documentation was obtained. LPA Irra conducted in person tours and observed telephone to be operational and accessible to residents. Staff interviews were also conducted. Per staff interviews, residents are not prevented from making nor receiving phone calls. However, per staff interviews, most residents residing at this facility do not use the telephone often due to their dementia and/or family involvement. Per staff interviews, staff are trained in resident rights. LPA was unable to interview R-1, R-2, R-3, R-4 and R-6 as they are no longer residents at this facility. R-5 was resting during today’s visit. During today’s visit, LPA interviewed R-7, R-8, R-9. Resident interviews revealed that residents are able to make and receive phone calls. Interviews conducted do not corroborate this allegation. Allegation: Medication not properly discarded. During this investigation, staff interviews were also conducted. Per staff interviews, staff properly discard medications. Staff interviews revealed they are trained in medication administration including destruction of medication. LPA was unable to interview R-1, R-2, R-3, R-4 and R-6 as they are no longer residents at this facility. R-5 was resting during today’s visit. During today’s visit, LPA interviewed R-7, R-8, R-9. Resident interviews revealed that medication is administered as prescribed. Interviewed residents were not aware of the facility’s medication discarding procedures. Interviews and collected documents do not corroborate this allegation. Refer to LIC 9099C for the continuation of this report. Allegation: Facility has mold. During this investigation, facility tours (virtual and in person) were conducted, Resident #1 through Resident #6 (R-1 through R-6) files were reviewed and relevant documentation was obtained. LPA Irra conducted in person tours on 04/14/22, 04/28/22, 05/11/22, 05/26/22 and 06/08/22 and did not observe mold in the facility. Staff interviews were also conducted. Per staff interviews, facility does not have mold. LPA was unable to interview R-1, R-2, R-3, R-4 and R-6 as they are no longer residents at this facility. R-5 was resting during today’s visit. During today’s visit, LPA interviewed R-7, R-8, R-9. Resident interviews revealed that the facility does not have mold. Interviews and tours conducted do not corroborate this allegation. Based on LPA's interviews conducted and records reviewed, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated. No Deficiencies cited under California Code of Regulations Title 22. An exit Interview was conducted, appeal rights and a copy of this report was provided to Laura Hernandez. Allegation: Resident not provided with proper bed. During this investigation, facility tours (virtual and in person) were conducted and staff interviews were conducted. LPA Almaraz observed R-2’s bed to be on the floor during the virtual tour conducted on 11/30/2020. Staff interviews revealed R-2’s bed was on the floor due to R-2 being a fall risk. LPA Irra conducted tours of this facility on 04/14/22, 04/28/22, 05/11/22, 05/26/22 and 06/08/22 and did not observe any beds to be placed on the floor. R-2 was not interviewed as R-2 moved out of this facility. LPA Almaraz’s observation and staff interviews corroborate this allegation. Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the allegation is found to be substantiated. Health and Safety Code Title 22, Division 6 and Article 3 are being cited on the attached LIC 9099D. An exit Interview was conducted, appeal rights and a copy of this report was provided to Laura Hernandez.