Complaint·November 4, 2022

Allegation: Staff hit resident’s in care. During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above. LPA received copies of in-service training documents. LPA did not observe any resident to have any visible injuries. LPA reviewed incident reports and did not observe any reports of staff hitting a resident while in care. LPA interviewed residents (R1-R10). 9 out of 10 residents stated staff has never been physical with the resident’s in care. Residents (R1-R10) stated residents have no issues with safety living here. Administrator stated there has been no concerns of a staff hitting a resident while in care at the facility. 6 of 6 staff stated staff has not witnessed any staff hitting a resident while in care. 6 of 6 staff has never had a resident report to staff that a staff hit a resident while in care. There is no evidence to support the allegation that staff hit resident’s in care. Allegation: Staff locked resident in their room. During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above. LPA received copies of in-service training documents. LPA did not observe any resident’s rooms to be locked during tour of the facility. LPA reviewed incident reports and did not observe any reports of staff locking resident in their room. LPA interviewed residents (R1-R10). 10 of 10 residents stated there are no concerns with staff locking a resident in a room. Resident’s (R3, R5, R6) stated staff help open the door to room. Administrator stated there has been no reports of staff locking residents in their room. 6 of 6 staff stated staff has not witnessed any staff locking resident in their room. There is no evidence to support the allegation that staff locked resident in their room. Allegation: Staff gave wrong medication to resident in care. During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above. LPA observed the medication sorting and system used for distribution of the medication. LPA observed MARs book including each resident prescription, bubble pack of medications, sorting tray with name on each slot and medication cup with name on cup for each resident as a monitoring system to ensure accuracy of the distribution of medications. LPA received copies of in-service training documents. LPA reviewed incident reports and did not observe any reports of staff gave wrong medication to resident in care. LPA interviewed residents (R1-R10). 10 of 10 residents stated there are no concerns with staff giving the correct medications as assigned per the doctor’s orders. Administrator stated medications are sorted for two (2) days in the mornings and there is no issue with following doctor orders for medications. 5 of 6 staff stated staff distribute medication as assigned on medication trays. 1 of 6 staff does not work with the medications. Per staff (S1-S4, S6) if resident questions a medication due to size or color change, resident and staff go to Administrator to discuss any concerns from the resident. There is no evidence to support the allegation that staff gave wrong medication to resident in care. Allegation: Staff refuse to assist resident with their showers. During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above. LPA received copies of “bath schedule” for each caregiver responsibility. LPA obtained a refuse to shower log signed by a resident for those who refuse. LPA reviewed incident reports and did not observe any reports of staff refusing to assist residents with their showers. LPA interviewed residents (R1-R10). 5 of the 10 residents receive assistance with showers and 5 of the 10 residents interviewed are able to shower themselves. 5 of 5 residents who do receive assistance with showers stated there are no concerns with staff assisting resident with showers. Continued on LIC 9099-C 5 of 5 residents who do receive assistance with showers stated staff have a schedule to follow for resident’s shower. Resident (R2) stated if resident refuses to shower staff has resident sign log refuse to shower. Administrator stated staff follow the shower schedule for the residents who need assistance to shower. Administrator stated resident sign log if resident refuses to shower. Staff (S1-S4, S6) stated staff follow the bath schedule to shower residents. Staff (S1-S4, S6) stated resident to sign book if refuse to shower. There is no evidence to support the allegation that staff refuse to assist resident with their showers. Allegation: Staff speak inappropriately to residents in care. During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above. LPA received copies of in-service training documents. LPA reviewed incident reports and did not observe any reports of staff speaking inappropriately to residents in care. LPA interviewed residents (R1-R10). The majority of the residents stated there are no concerns of staff speaking inappropriately to residents in care. Administrator has not witnessed staff speaking inappropriately to residents in care. Administrator stated no staff or residents have reported to Administrator that staff speak inappropriately to residents in care. Administrator stated staff will occasionally speak louder to residents who may have hearing issues. Staff (S1-S6) has not witnessed staff speaking inappropriately to residents in care. Staff (S1, S4) stated Staff (S1, S4) has spoken louder to residents who may have hearing issues. There is no evidence to support the allegation that staff speak inappropriately to residents in care. Allegation: Staff smokes inside the facility. During the course of the investigation, LPA was unable to find any witnesses supporting the allegation above. LPA did not observe anyone smoking in the facility during visits. LPA did not smell any smoke in the facility during the visits. LPA did observe smoking area on the premises. LPA reviewed incident reports and did not observe any reports of staff smoking inside the facility. Continued on LIC9099-C LPA interviewed residents (R1-R10). 10 of 10 residents have not witnessed staff smoking inside the facility. 10 of 10 residents state there is a smoking area in the patio designated for smokers. Administrator stated three (3) staff smoke and none of the staff smoke inside the facility. 6 of 6 staff have not witnessed staff smoking inside the facility. There is no evidence to support the allegation that staff smokes inside the facility. Allegation: Staff do not provide proper food service to resident’s in care. During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above. LPA observed menu posted. LPA reviewed incident reports and did not observe any reports of staff not providing proper food service to resident’s in care. LPA interviewed residents (R1-R10). 10 of 10 residents stated there are no concerns with the food service to residents in care. 10 of 10 residents stated residents get three (3) meals per day and snacks twice a day. Administrator and 6 of 6 staff stated residents are given three (3) meals a day and two (2) snacks. Administrator and 6 of 6 staff stated if there is extra food the kitchen will allow on a first come first serve basis to residents. Administrator and 6 of 6 staff stated if the resident has finished but not completely eaten everything on the resident’s tray then the staff will discard the remaining food. There is no evidence to support the allegation that staff do not provide proper food service to resident’s in care. Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegations listed above. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Assistant Administrator Cesilia Torres and a hard copy was provided.