complaint·August 19, 2021

Allegation: Staff did not meet resident's hygiene needs It is alleged Staff did not meet resident's hygiene needs. On 06/10/2021 LPA Calderon and LPM Hammond interviewed the Administrator S1, S1 stated Hospice was responsible for providing baths to the resident, but this was not being done. Administrator stated S1 reached out to Hospice to remind them of that responsibility. Staff states hospice was responsible for bathing R1. The Administrator stated the facility staff are responsible for providing bed baths to R1, but it was not being done which contributed to ants crawling on the R1 face. LPA Calderon reviewed R1 file and observed the hospice Care Plan does include bathing. LPA Calderon could not interview R1 due to communication problems. LPA Calderon interviewed R2 -R13 most but not all stated that they took their own baths and did not need staff help. Allegation: Facility did not ensure facility was free from pests: It is alleged that the Facility did not ensure facility was free from pests. It is alleged that R1 had ants on R1 face, mouth, ears and body while sleeping. On 6/09/2021 LPA Calderon interviewed R1 family member who stated W1 visited R1 on 6/5/2021 and noted ants on R1 face and body and then W2 visited R1 on 6/7/2021 and took video of large number of ants on R1 face. On 6/10/2021 LPA Calderon interviewed S1 and on 6/10/2021 LPA Calderon interviewed S2-S8 who all stated ant problems in the facility and stated ants in room 103, 105, 130, 130 and 143. On 6/10/2021 LPA Calderon interviewed R2 – R13 and 5 out of 13 residents stated ant problems in the facility. LPA Calderon could not interview R1 due to communication problems. On LPA Calderon received and reviewed 2 videos taken from W1 members on 6/5/2021 and 6/7/2021 which shows ants on R1 who was sleeping in the bed. Based on LPM and LPA observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8) are being cited on the attached LIC 9099D. A exit interview was conducted with Administrator Peggy Clark, and a hard copy was provided for records