Complaint·December 12, 2023

During the tour, the LPA observed missing blinds in resident rooms #3, #6, #7 and in the living room. At 9:50 a.m. the LPA observed the restroom in room #2 to be unkept with the resident’s toilet being soiled, and stains observed on the cabinet doors of the sink and residue stains on the sink. At 9:53 a.m. the LPA observed the resident’s restroom in room #3 to be unkempt with urine at the feet of the toilet and the room smelled of urine. At 10:13 a.m. during the kitchen physical tour the LPA observed the following food items expired: 1 half finished gallon of cranberry juice with best before date of 26 NOV23 and 7 Jars of Traditional Alfredo sauce with the best if used by SEP-07-23. At 10:21 a.m. the LPA observed the additional refrigerator in the garage with yellow stains on the door. Based on observations, there is sufficient evidence to support the above allegation of Facility is in disrepair occurred. Therefore, the allegation is deemed Substantiated at this time. Facility staff fa iled to properly administer resident’s medications and Facility failed to maintain complete and accurate resident records. On the allegations, of Facility staff failed to properly administer resident’s medications and Facility failed to maintain complete and accurate resident records, it is the reporting party’s concern that the facility has medication errors and incomplete resident records. To investigate the allegations, the LPA conducted a medication audit for three (3) out of six (6) residents at 1:18 p.m. The medications were stored in a locked cabinet in the dining room. During Resident #1 (R#1's) audit, the LPA observed Omeprazole not properly documented on the centrally stored medication and destruction record (CSMDR), as the Instructions did not match the prescription label. On the CSMDR, the instructions were documented as follows: take 1 cap po bid. When asked, staff revealed that bid meant twice a day, however the medications prescription label instructions read as follows: Take 1 capsule by mouth once daily before breakfast. The Medication Administration Record (MAR) reflects the medication only being given once daily, however when staff did a medication count of Omeprazole, the count was off, with three more capsules in the bottle than needed based on the start date. During R1’s audit, the LPA also observed Ezetimibe not properly documented on the CSMDR with the wrong expiration date and prescription number as the bottle did not have a prescription label and was an over-the-counter medication. The LPA also observed R1’s Losartan not properly documented on the CSMDR as the expiration date did not match the prescription label. Report will continue on LIC9099-C. During Resident #3’s (R3) audit, the LPA observed a bottle of Multivitamin Men 50+ without a prescription and not documented on the CSMDR. The LPA also observed R3’s Latanoprost 0.005% solution and Timolol Maleate 0.5% solution not documented on the CSMDR. Based on the medication audit and medication records review, there is sufficient evidence to support the above allegation of Facility staff failed to properly administer resident’s medications and Facility failed to maintain complete and accurate resident records. Therefore, the above allegations are deemed Substantiated at this time. Pursuant to Title 22 Division 6 of the California Code of Regulations the facility was in violation as follows (see 809-D): Exit interview conducted with administrator Kian Pascual. Today's reports and appeal rights were reviewed and issued. The LPA reviewed the facility schedule and observed two (2) to three (3) staff members on schedule during the morning/day shift (8:00 a.m-8:00 p.m.), and one staff member on schedule during the night shift (8:00 p.m.-8:00 a.m.) to take care of six residents. The LPA also observed an on-call staff on the schedule. When the LPA arrived for today’s visit the LPA observed two staff present caring for six residents. Staff were observed by the LPA to be taking care of the residents and assisting the residents every time the residents would call throughout the visit. During today’s visit the LPA also interviewed Resident #3’s (R3) family member. R3’s family members interview revealed that in combination with their daughter, they come to visit R3 around five (5) times a week and that there’s always at least two to three staff on shift. R3’s family member also stated that staff is “always very responsive” and that they have no concerns regarding the care R3 receives. Staff interviewed (Staff #1) revealed that there’s always two staff working during the morning/day shift and one staff during the night shift. S1 also revealed that if night shift staff needs assistance, they can call for assistance to the staff that lives in the facility by knocking on their door. The LPA also interviewed one (1) resident (Resident #2) to investigate the allegation, and R2’s interview revealed that they do not require assistance from the staff. Based on interviews, observation and file review, the allegation Facility is not adequately staffed is deemed unsubstantiated at this time. Facility failed to maintain a complete and accurate staff records. Regarding the allegation: Facility failed to maintain a complete and accurate staff records, the LPA conducted a file review to investigate the allegation. The LPA reviewed five (5) out of ten (10) staff files. The LPA reviewed five staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, and current first aid/CPR cards. All files were complete. Based on file review, Facility failed to maintain a complete and accurate staff records is deemed unsubstantiated at this time. Exit interview conducted and report issued to Administrator Kian Pascual.