complaint·May 24, 2023

The investigation revealed the following: Regarding allegation: Facility did not report injury to proper agencies. It is alleged facility staff did not reported injury to community care licensing division (CCLD). During resident file review, no incident report, death report, or hospice notification were observed for R1. During interview with administrator Laura Aguilar stated to not have submitted an incident report, death report, or hospice notice for R1 to the department. LPA reviewed submitted documents to the department prior to the visit and did not find incident report or death report. Based on interviews and observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . Regarding allegation: Facility failed to provide refund after the death of the resident. It is alleged facility has a no refund for monthly fees after the death of a resident. During file review, admission agreement was observed to have been signed and initial on 8/30/21. R1 was admitted to the facility on 8/30/21 and passed away on 1/12/23. Invoice provided to the R1's family representative fees were charge for the month of January 2023. Interview with administrator revealed the facility did not provide a refund after the death R1. Per administrator family representative remove all R1's personal belongings on 1/14/23. Based on interviews and observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . California Code of Regulations, Tittle 22, Division 6 and Chapter 8 are being cited. Exit interview was conducted with Laura Aguilar Administrator and a copy of this report, LIC 9099D, and appeal rights were provided. The investigation revealed the following: Regarding allegation: Facility did not reimburse responsible party fees for incontinence care supplies. It is alleged family representative requested a reimbursement for the charge of unused diapers as 4 boxes were purchase and only a box could have been used during that time. Interview with residents revealed 1 out of 3 residents stated not to have incontinence needs and LPA was unable to interview 2 out of 3 residents due to cognitive skills. Interviews conducted with staff revealed, 3 out of 3 staff stated R1 was change between 4-6 times throughout the day and 2 out of the 3 staff stated R1 was changed between 5-6 times at night. Interviews with resident's representatives reveal 2 out of 3 representatives stated to provide or pay additional fee for incontinence care products, which are stored in the resident's rooms. Representatives stated to know the number of diapers being used. 1 out of 3 representatives was unable to be reach for an interview. Per administrator diapers were kept in residents room and if there were any diapers left they would have been in room for family to pick up. Also stated, diapers were used starting the month of January until she left. R1's representative did not observed any diapers in the room at the time personal items were picked up on . Document review revealed facility does not maintain a changing log for residents and no additional notes on incontinence care were observed. Invoice dated 12/26/22 for fees due by 1/1/23 for the month of January 2023 notes a charge of $76.00 for 4 packs of 18 briefs each. Based on the fact that diaper use for each resident is not logged, it could not be determined how many, if any diapers were left after R1's 1/12/23. Based on interviews and observation, the preponderance of evidence standard has been met, therefore the above allegation is found to be UNSUBSTANTIATED . Regarding allegation: Resident sustained an injury while in care due to lack of supervision. It is alleged on 12/30/22 R1 sustained a broke wrist while in care. Interview with residents revealed 1 out of 3 residents stated facility's care and supervision is proper to resident's needs and LPA was unable to interview 2 out of 3 residents due to cognitive skills. Interviews with staff revealed, 3 out of 3 staff stated a staff was usually with R1 when moving around the facility and that on 12/30/22 R1 per usual was moving around with walker, after finishing breakfast R1 got up to sit on reclining chair with S3 assisting her. Upon attempting to seat R1 loss balance and arm slipped by chair's arm rest. At the time of the incident R1 did not complain of pain, there were no marks, or cuts visible. In the evening staff notice a bruise and notify administrator immediately. Administrator notified family representative, who requested R1 be taken to urgent care in the morning. Interviews with family representatives revealed 2 out of 3 representatives interviewed are satisfied with the care and supervision provided at the facility. (CONTINUED ON LIC 9099C) 1 out of 3 representatives was unable to be reach for an interview. Documents reviewed reveal power of attorney to make medical decisions for R1 is held by family member who requested R1 to be taken to urgent care the next morning instead of the evening of the injury. Based on interviews and observation, the preponderance of evidence standard has been met,. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Laura Aguilar administrator and a copy of this report was provided.