complaint·January 4, 2024

Regarding Allegation #1: Staff neglect properly cleaning resident when providing incontinent care. It is being alleged that staff neglected to properly clean R1 when providing incontinent care. LPA Calderon toured the facility with A1. During tour of the facility LPA noted staff going into resident rooms to provide incontinent care. Records reviewed indicate the following: LPA reviewed in service training conducted on 02/09/2023 regarding cleaning/showering for R1. In service training indicates staff provided showers 3 times per week or when needed and cleaning directions. The facility service plan (date 05/10/2023) for R1 indicates that staff are to give assistance with bathing to R1 3 times per week. Interviews with staff indicate the following: The Excel home health care provided incontinent training to staff regarding colostomy bag leaks. the fecal matter. Staff provides showers to R1 3 times per week or when needed and R1 refuses to take more than 1 shower per week. Interviews indicated the following: 4 out of 4 staff indicate there was training provided by Excel home healthcare staff on leaking colostomy bags, residents are provided with 3 showers per week or when needed, that R1 refuses to take more than 1 shower per week, and that R1 colostomy bag does leak and R1 touches R1 fecal matter and staff cleans R1 when this happens. 2 out of 2 witnesses indicated the following: that training was provided to facility staff for colostomy bag leaks and cleaning training for fecal matter, and that home health care is aware of R1 colostomy bag leaks due to age and overall health conditions. R1 indicated that R1 has 3 fistulas on R1 left side of the stomach, the colostomy bag does leak, home health care and facility staff are aware of the leaking bag, that there is fecal matter on R1 stomach area, but not all over R1 body, staff does offer R1 3 showers per week or when needed, but R1 refuses to take more than 1 shower per week, and R1 admits that R1 should take more than 1 shower per week but does not. R1 indicates that R1 is happy with the services provided by the staff. 5 out of 5 residents denied the allegation for colostomy bags and staff do provide 3 showers per week to residents. Regarding Allegation #2: Staff are not following medical orders.It is being alleged that staff are not following wound care orders. During the investigation, LPA observed that 2 caregivers reposition per doctor’s orders as indicated in R1’s wound care. Records reviewed indicate: Needs and services plan dated 05/10/2023 indicates that staff are to provide 3 showers per week and staff will assist in colostomy care. Records reviewed indicate the following: Physician report dated 02/01/2023 indicates that colostomy bag is needed for R1. Service plan dated 05/10/2023 indicates that staff are to aid R1 for bathing or showering 3 times per week. Excel Home Health Care in-service training for dated 02/09/2023, indicates that staff are to provide shower 3 times per week and to make sure to check that R1 is clean and taking showers and that staff are to assist in R1’s colostomy care. In-service training dated 04/16/2023 indicates that Staff are to change R1 colostomy bag every two days or if there is leaking outside of the colostomy bag. Interview conducted indicate the following: Excel Home Health Care staff did provide training to facility staff on colostomy bags leaks, fecal leaks, and open wounds and how to attach the bag to R1 body. Excel Home Health Care provided additional training to staff on how to shower R1 by A1. A1 indicated that staff did follow doctors’ orders for colostomy bag and cleaning of fecal matter from R1. 4 out of 4 staff indicated that f ormal training was provided by home health care staff regarding colostomy bag and fecal matter cleaning for R1. 4 out of 4 staff indicate they did receive in-service training in colostomy bag services and showering for R1. 4 out of 4 staff state they follow medical orders for R1 care. 2 out of 2 witnesses stated that that facility staff were provided training on how to change a leaking colostomy bag and how to clean R1 fecal matter per doctor’s order. 2 out of 2 witnesses indicate the last call to home health care for R1 leaking colostomy bag was on 08/28/2023 and training was provided to facility staff per doctor’s orders. 4 out of 5 residents indicate that the home health care staff provided training to facility staff regarding R1 leaking colostomy bag and cleaning fecal matter per doctor order. R1 indicates that facility staff do follow doctors’ orders and R1 is happy with the services provided by staff. 4 out of 5 resident indicates that they have no need for colostomy bags and residents indicates that they have seen facility staff training. 4 out of 5 residents indicate that they are happy with staff services and resident indicate that staff do follow doctors’ orders. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegations of “staff neglect properly cleaning resident when providing incontinent care”, “staff are not following medical orders” is found to be UNSUBSTANTIATED. No deficiencies cited during today's visit. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Kenia Padilla A1.