Complaint·November 18, 2021

INVESTIGATION REVEALED THE FOLLOWING: Allegation: Illegal eviction It is alleged that facility staff refused entry to facility upon return from hospital. LPA spoke to Administrator Matan Burstyn regarding allegation. Per Ms. Burstyn, no residents have been issued eviction notices but the spouse of R1 decided to move them from facility. There was no discussion with spouse of R1 about R1 returning to facility or a refusal of R1’s return. LPA spoke to S1 who stated that R1 had been hospitalized several times recently, and a request was made that R1 be evaluated at hospital during their last visit. LPA reviewed facility files which state that hospital called facility to say resident was ready to be released and when results of the evaluation were request, hospital stated it was not needed. Facility requested an evaluation be completed before readmission to the facility and hospital staff hung up. R1 and spouse returned to facility, collected some of R1’s items and left. LPA looked for an eviction notice in facility files and none were found. LPA spoke to residents 2 – residents 7 regarding allegation. Out of those interviewed, seven out of seven residents stated they have not been evicted nor do they know anyone who has been evicted. LPA Cifuentes interviewed staff 1-staff 8 regarding allegation. Of those staff interviewed, seven out of eight stated that residents had not been evicted. Based on information gathered and service records reviewed, the Department did not find sufficient evidence to support the allegation mentioned above. The Department’s investigation consisted of an inspection of the facility, observation, analysis of residents records and interviews conducted and found no evidence to support the allegations: “ Illegal eviction” 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 allegation is Unsubstantiated . Exit interview conducted, and a copy of the report was given to Aurora Israelson. INVESTIGATION REVEALED THE FOLLOWING: Allegation: Facility nurse did not ensure memory care resident did not have access to ingestible objects It is alleged that Resident 1 (R1) ingested soap, rubber gloves and Halloween decorations while at the facility. LPA Cifuentes spoke with Executive Director Matan Burstyn regarding the allegation. Per Executive Director, facility found that resident had coffee grounds in her mouth. The facility was still observing the resident, to make sure they adjusted to the move in and were being assessed correctly. Once coffee was consumed the facility increased supervision. LPA reviewed records and per facility notes on 10/18/2021 Coffee Grounds and orange juice were found in residents’ mouth. On 11/6/2021 R1 was found with a bar of soap that had teeth marks and on 11/7/2021 gloves, masks and flower decoration where found and thought to have been ingested by resident. LPA spoke to residents regarding allegation and whether facility could accommodate their needs. Of the six questioned, all 6 stated their needs were being accommodated. LPA Cifuentes spoke with facility staff, of the eight questioned, seven stated that a resident had ingested objects. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Based on information gathered, the department did find sufficient evidence to support allegation " Facility nurse did not ensure memory care resident did not have access to ingestible objects” Based on interviews conducted and records reviewed the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of the LIC 9099 and appeal rights forms were provided to Matan Burnstyn.