complaint·March 7, 2024

LPA interviewed a total of 8 facility personnels, 11 residents, and reviewed documents to determine the findings for this allegation. According to staff interviews, R1 has a history of menstrual bleeding. Some staff stated they assisted R1 with changing the pad when R1 requested help. Staff did not observe substantial bleeding from R1 that appeared alarming when they showered or changed R1. They also stated R1 mainly requested help with bathing and changing and did not share the medical history with staff. However, when R1 requested the facility’s help in arranging medical appointment, staff did so. For this incident, staff recalled checking on R1 during their shifts and did not see any signs of distress on R1 days prior to hospitalization. When R1 reported feeling weak, the staff asked if 911 should be called. Per R1, resident did not want them to contact 911, but rather, to arrange for a telehealth visit. Staff assisted with the request and R1 spoke with the doctor. Per the physician’s recommendation, R1 should be evaluated at the hospital and staff tried to assist in arranging non-emergency transportation. Staff informed R1 there were no bariatric transportation on that day and will continue to find one. In the meanwhile, R1 did not disclose to staff about the menstrual bleeding nor symptoms that required immediate medical attention until the next day. Staff immediately called 911 when R1 requested it. Based on information gathered, R1 appeared to be self-independent with medical needs and did not fully share the medical history with the facility. Staff could not have known the significant amount of blood loss. LPA interviewed a total of 11 residents. 7 out of the 11 residents, who need some assistance from staff, indicated that staff assisted right away when they asked for help. Some residents, who had requested medical attention, stated that staff provided medical attention in a timely manner. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Cynthia Flores. A copy of this report along with the appeal rights were provided.