complaint·June 2, 2022

The investigation revealed the following: R egarding allegations: Staff are physically abusive to resident and resident sustained injuries while in care . It is alleged R1 is getting abused by the staff and has bruises on arms . On 11/3/21 LPA Flores conducted a tour of the facility and observed residents in care, R1 was observed in bed, arms and chest was visible no bruises were observed. Interviews with residents revealed 2 out of 5 residents stated staff are nice, helpful, and know how to care for them. 2 out of 5 residents were unable to answer due to cognitive skills, and 1 out of 5 residents stated staff has not left bruises when caring. Interviews with staff revealed 5 out of 5 staff stated staff are respectful to residents, have not observed bruises in residents arms, and have received training on personal rights. Documents reviewed revealed staff received training on resident's personal rights and a signed copy is maintain in the staff's file. 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 allegations are UNSUBSTANTIATED . Regarding allegation: Staff are not assisting resident with incontinence needs. It is alleged resident "sits on pee and poo". Interviews with residents revealed 2 out of 5 residents stated to receive assistance with incontinence care, 1 out of the 2 stated to be assisted every 2 hours and 1 out of 2 was unable to determined time frame of assistance. 2 out of 5 residents were unable to answer due to cognitive skills. 1 out of 5 residents stated to be assisted to use the bathroom when needed. 5 out of 5 staff stated to have received training on incontinence care, 4 of the 5 staff stated residents with incontinence needs are changed every 2 hours and 1 of the 5 staff stated residents are change 3 times during the day and 3 times during the night. Documents reviewed revealed 2 out of 5 residents need assistance with incontinence care, facility does not maintain a log for incontinence care, and staff training regarding incontinence care was provided to staff within the year. 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 allegations are UNSUBSTANTIATED . Regarding allegation: Staff are not assisting resident with transfers. It is alleged staff does not take R1 out of bed. Interviews with residents revealed 2 out of 5 residents stated to be assisted with getting out of bed/chair when needed. 2 out of 5 residents were unable to answer due to cognitive skills, and 1 out of 5 residents stated to not be assisted getting out of bed. (CONTINUED LIC 9099C) Interviews with staff revealed 5 out of 5 staff stated to assist the residents with transfer from bed to chair, provided by 2 caregivers, and to have received training for proper transfer care including use of hoyer lifter. 2 out of the 5 staff stated R1 chooses to return to bed after being assisted out of bed most of the time. Documents reviewed revealed R1 has noted motor impairment on physician's report. LPA reviewed Lift Program Policy and Guide for staff training within the last year. 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 allegations are UNSUBSTANTIATED . Exit interview was conducted with Paula Mera Caregiver and a copy of this report was provided.