complaint·August 25, 2023

Allegation: Facility staff failed to provide meal service to residents in their rooms. The allegation entails that staff forgot to turn in meal slips for resident who receive meals in their room, because of this three (3) residents did not receive their meals. During interviews with staff (S1-S5), four (4) out of five (5) staff stated they check on residents who receive room service to ensure they have gotten their food, and if they did not, they will get it for them. Interviews with residents (R1-R6), six (6) out of six (6) residents say they get three (3) meals a day and snacks in-between meals. Five (5) out of six (6) residents (R1, R3, R4, R5 and R6) stated sometimes it takes a while for their food to come because they know staff are busy, but it does come. Resident R2 stated if it takes too long for their food to come up their caregiver will go down and go get it. During a tour of the dining room and meal service, LPA observed all residents got their meals and the cart for room service was on its way up to residents room. Unsubstantiated Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Allegation: Facility staff did not respond to residents’ call buttons in a timely manner. The allegation entails that a residents pressed their call light for assistance to the restroom and the resident had to wait thirty (30) minutes for assistance. Interviews with staff A1 and S1-S5 revealed the following. During interview Administrator (A1) stated staff respond to pendant call buttons as soon as possible. Staff S1 stated they try to respond as soon as possible but it they are assisting another resident it could take some time. Staff (S2-S5), four (4) out of four (4) stated, they try to go as soon as possible but it can take 15 to 40 minutes before we are able to respond. Interviews with residents (R1-R6) revealed the following. Residents R1 stated the soonest a caregiver has come to assist, after pressing the call button, was 10 minutes and the longest has been over an hour. R1 also stated, they had to wheel themselves to the door and was yelling for help, and still no one came. R1 stated they had to call their family who called the front desk for R1 to get assistance. Resident R2 stated they hired a private caregiver because they tried the pendant, but staff were busy, and R2 couldn’t wait. Interviews with residents R 3 and R4, two (2) out of two (2) stated staff never come when they press their pendants. Resident (R5) during interviews stated, when they press their pendant, it takes 30-40 minutes before a caregiver comes. Additionally, R5 stated they now call the front desk when they need assistance because the caregivers take to long. During an interview, LPA and R2 pressed the call button and it took staff 23 minutes for staff to respond to the call button. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California code of Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D .