Follow-up·September 12, 2022

Licensing Program Analyst (LPA) Fernandes-Goes arrived unannounced with the purpose of closing a complaint investigation. During subsequent complaint investigation Department learned there are related deficiencies observed during the visit. LPA met with Catherine Scott - Administrator. Following item were observed during investigation visits: Department observed during resident’s R4 file review and staff S2 interview on 8/17/2022 that resident R4’s physician assessment dated 7/15/2022 has a diagnostic of Type 2 diabetes; resident came back from SKNF with order for Humalog 100 units 3x a day and glucose testing needed; resident R4 physician’s assessment states that R4 can’t manage his medication including injections and glucose testing; on 7/21/2022 facility faxed doctor stating “ Resident back from SNF insulin VIAL order sliding scale,” and requesting a new order for Lispro inulin – “Insulin pen need to be available in order for Medication Technician to coach resident on getting it once nurse is not available during weekend.” According to records reviewed Lisopro filled 8/2/2022 and for the month of August 2022 resident R4 has self-administer its own injection and glucose test from 8/1/2022 to 8/16/2022. (see copy of documentation, LIC 811 confidential name list, LIC 809-D) Per Title 22 Regulations #87628 Diabetes “ The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional.” (Continued LIC 809-C) In addition, facility have not submitted Department with incident reports that are required for any missed medication, refusal of medication, and/or 911 calls including when a resident have refused and/or have been taken to ER as follows: Resident R1 medication refusal on 8/12/2022 and 7/6/2022 for 5 days; resident R2 for missing medications of Losartan from 8/2 to 8/10/2022, Amoldine 5/22 to 5/23/2022, and Elequilis from 4/23 to 4/26/2022; Resident R3 Azelastine 8/7/2022 “not administered”, Omeprazole 5/1 to 5/5 and 6/20 to 6/30/2022 “not available”, Valsartan 6/1 to 6/14/2022 “not administered”, 911 contacted for fall on 6/23/2022 – family refused that resident was transported to ER; Resident R4 medication refusal 5/20/2022, 911 contacted on 4/14/2022 fue to a fall, resident sent to ER due to a fall on 6/12/2022, medication refusal on 6/23/2022 w/ 911 contacted and ER refusal by resident, and ER visit on 6/24/2022. (see copy of documentation on file, LIC 811 confidential name list, LIC 809-D) Department is requesting a death certificate for resident R5 that passed away on 9/4/2022. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.