Complaint·December 28, 2023

Resident 2 (R2) was interviewed regarding the complaint allegations and R2 confirmed R1 would come to the table and eat with the rest of the residents. R2 stated the caregivers would give all the residents the same amount of food and something to drink. Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegations: Resident was severely dehydrated due to neglect and Staff did not ensure resident is being fed, occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, both allegations are deemed Unsubstantiated. Licensee/Administrator Rasouli contacted R1’s responsible party and informed them of the change in condition and requested to send R1 to the hospital due to the change in condition. A review of MemorialCare Saddleback Medical Center records indicate Resident 1 (R1) was admitted December 20, 2020. R1 was assessed and active problems were discovered: Pneumonia/COVID 19 (Principal Problem) Acute respiratory failure with hypoxia Senile dementia without behavioral disturbance Oral phase dysphagia Severe protein-calorie malnutrition Encephalopathy due to COVID-19 virus Pressure ulcer of left heel, unstageable A review of MemorialCare Medical Center progress notes by Physician 1 (P1), dated December 22, 2020, stated the following: Patient has profound dysphagia unable to initiate eating and without demonstrated ability to swallow safely. This is likely the result of end stage dementia more so than COVID-19 infection though the latter is contributing. Dysphagia and disinterest in eating is a chronic process as witnessed by 25-pound weight loss since February 2020 and chronic hypernatremia that demonstrated insufficient free water intake. I advised patients [responsible person] that the patient is at the end of life. Treatment for COVID-19 was unlikely to turn around what has been a chronic and slow process that began before any infection. Interviews with facility staff members, California Mission Hospice Nurse, and a home Health Nurse all revealed R1 was fed, and the resident’s appetite would vary. According to the Hospice Nurse, R1 was eating 80% – 90% of his meals. December 16, 2020, was the last time Hospice visited R1 and it was reported the resident was eating 60% - 70% of his meals. A Home Health Nurse revealed R1 had a good appetite, but R1 did lose weight due to his dementia diagnosis. Continued on LIC9099C