complaint·March 10, 2022

R1 was assessed and assisted back onto their wheelchair immediately after. This concludes that staff was present and provided care and supervision to R1 even though R1 fell. Based on the interviews conducted and observations, there was not enough supportive evidence to concur with the reported allegation. 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. In regards to the allegation "Staff did not notify authorized representative of an incident involving a resident ", it was alleged that R1 fell on 3/1/22 and R1's authorized representative was not notified in a timely manner. (6) of (6) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews show that R1 fell around 5:40pm and family was contacted minutes after. Staff spoke to R1's authorized representative via phone call after speaking to a separate family member first. R1's authorized representative arrived to the facility within an hour after hearing of the incident as well. Review of documents on file show that R'1s authorized representative is also the durable power of attorney (DPOA). Interviews show that although R1's DPOA was not contacted first, they were still contacted in a timely manner. Based on the interviews conducted and observations, there was not enough supportive evidence to concur with the reported allegation. 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. In regards to the allegation "Staff did not seek timely medical attention for a resident", it was alleged that staff did not assess R1 and provide first aid on 3/1/22. (6) of (6) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews show that R1 was assessed after falling and no physical injuries were observed that required immediate medical attention besides first aid care. R1 was assisted to their room and provided an ice pack by staff. LPA Villalobos reviewed an incident report stated that Resident was assessed and provided first aid. Based on the interviews conducted and observations, there was not enough supportive evidence to concur with the reported allegation. 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. Continued on LIC 9099-C In regards to the allegation "Facility has inadequate record keeping ", it was alleged that the facility does not keep hospice care documents and notes on file in order to contact them regarding any incidents or changes that occur with R1. (6) of (6) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Interviews show that on 3/1/22 facility staff did contact R1's hospice agency about R1's fall. Hospice agency staff confirmed. LPA reviewed R1's files in the facility and was provided with R1's Hospice binder with contact information. Based on the interviews conducted and observations, there was not enough supportive evidence to concur with the reported allegation. 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. In regards to the allegation "Facility has inadequate staffing for the facility", it was alleged that facility staffing is not enough to provide adequate care and supervision to residents. (6) of (6) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. Review of staff roster demonstrates that the facility keeps med techs and caregivers on all shifts. Interviews show that even though 2 staff quit recently, other staff have worked overtime and the facility works with a 3rd party agency in order to keep the facility staffed. During the visit LPA observed sufficient staffing providing care and supervision to residents. Based on the interviews conducted and observations, there was not enough supportive evidence to concur with the reported allegation. 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. In regards to the allegation "Resident's sliding door is in disrepair ", it was alleged that the sliding door in R1's room did not lock. (6) of (6) Staff interviewed denied the allegation. (6) of (6) Residents interviewed could not corroborate the allegation. LPA toured the room with S1 and S1 was able to demonstrate that the door locked. LPA also recorded the door being locked. Based on the interviews conducted and observations, there was not enough supportive evidence to concur with the reported allegation. 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. Citation is being cited on a separate 809. Exit Interview conducted with administrator Sophia Chan and a copy of this report was provided.