complaint·March 20, 2023

The investigation consisted of the following: LPA interviewed two (2) staff (S1 and S2), administrator and six (6) residents (R2-R7), R1’s family member and R1 via telephone and obtained R1 documents including the face sheet, physician report, resident appraisal, functional capacity assessment, hospice documents and medication lists. The investigation revealed of the following: Allegation "Staff restrained resident in care. "LPA interviewed residents and reported staff did restrain resident with a cloth belt. LPA interviewed staff and admitted they did put a belt on R1's recliner to prevent R1 to get up and fell as R1 has a history of fall. The administrator also reported they were using the postural support on R1 but it's not tight at all. They were using the postural support because they were trying to prevent resident to get up and fell as R1 likes to get up all the times. Administrator also indicated R1’s family member was acknowledged the postural support for R1 and did see the picture of the postural support and it was not considered as a restraint on R1. During the record review, LPA observed the postural support (gait belt) that R1 used which was not prescribed by R1’s physician. Based on the interviews conducted by staff and residents and record reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 is being cited on the attached LIC 9099D Exit interview held/copy of report and appeal rights provided. LPA interviewed staff and all denied the allegation too. Staff reported all residents need assistance with toileting except one resident. They would never reject resident to go to the bathroom. They would assist resident with changing diaper every two hours or as needed. During the record review, R1 is incontinence and requires assistance with toileting needs. R1 was not able to go to the bathroom alone. Based on interviews conducted and recorded view, 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. Exit Interview Conducted and A copy of the report was provided to Administrator Lorraine Lopez.