complaint·January 29, 2026

When residents press their pendants and request a diaper change, staff will change them right away. Staff stated they also change the bed pads and ensure the residents are clean and dry. LPA interviewed ten (10) residents and all of them stated that staff change them frequently and never ran out of diapers. Allegation - Staff do not assist residents with showering. Per the administrator and staff, residents are showered on their assigned days. Some residents get more days depending on what they request during admission or their care plan. However, it was noted that residents will also get showered if they are extremely soiled and require one. Staff stated that all showers completed or refused are documented. The residents interviewed stated that staff shower them at least twice a week or provide supervision for those who can shower on their own. Allegation - Staff are not addressing pests at the facility. The administrator and staff stated that the pest control company provides services at least once a month and have not observed any pests at the facility. Records of monthly pest control services were provided. LPA reviewed the service reports from the Pacific Shore Pest Control company. Records showed that the technician sprayed the exterior foundation of the facility and treated the interior of certain rooms/units for general pests. There were no indicators of live/new activity or infestation of pests at the facility. Nine (9) out of ten (10) residents interviewed have not seen any roaches, spiders, or gnats in their rooms or facility. One (1) stated he/she has seen gnats in the room, but staff sprayed the room to prevent them from coming back. Allegation - Staff are not safeguarding the resident's personal belongings. It is alleged that staff take the resident’s incontinence supplies to care for other residents. Per the administrator, the facility has a house supply of diapers/briefs, wipes, and chuks/bed pads. Administrator stated that many of the residents’ families will bring incontinence supplies, which are stored in the residents’ rooms. Staff stated they do not take any resident’s incontinence supplies to use on another resident. The facility has extra supplies of briefs, wipes, and under pads that staff stated they will access if the resident runs out of supplies. The residents interviewed have not seen staff take someone else’s products to use on them. Residents stated they have not run out of their incontinence supplies. LPA observed sufficient supplies of pull-ups/briefs, wipes, and bed pads in storage at the facility. Allegation - Staff do not provide residents with personal care supplies. It is alleged that staff do not have supplies of toilet paper at the facility. All the staff interviewed stated that the facility has ample supplies of toilet paper in storage. The bathrooms get replenished when housekeepers do the cleaning. If residents ask for additional rolls, they are provided with them. Staff have not observed or heard of staff not willing to give them an extra roll when requested. LPA toured the storage room and observed boxes of toilet paper. During the inspection of residents’ rooms, all the bathrooms had toilet paper. Nine (9) out of (10) residents stated that they have not run out of toilet paper, while one (1) stated that the staff did not give a roll when asked. Allegation - Licensee does not designate a substitute to manage the facility during absence from the facility. LPA obtained a copy of the designation of facility responsibility form with the name of the individual who is authorized to represent the facility when the administrator is not available. Staff interviewed stated the administrator is often at the facility. If the administrator is not present, there is a designated backup person is to manage the facility. The residents interviewed are not sure who the administrator is and there has not been a need to speak with her. Although the allegations may have happened or are 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 Staff B. Randolph. A copy of this report, along with the appeal rights, was provided.