complaint·May 30, 2025

Interviews with 8 out of 8 staff stated that R1 was not able to hold utensils on their own. It was also reported that due to the R1’s inability to hold utensils the resident would spill food on themselves during mealtimes. On November 28, 2024, R1 was visited by their family member, who reported they did not observe any burns on R1. The following day, on November 29, 2024, Witness interviews reported that R1 had burns on their chest. Photographic images obtained confirmed injuries on R1’s chest along with Facility progress notes dated November 29, 2024, in which staff notated that resident had a popped blister on their chest and small blisters on their chin. At the time of incident, R1 reported they had spilled coffee on themselves. Per interviews it was reported that R1 was given a cup of coffee at some point on November 28, 2024; However, no staff could confirm who provided R1 with the cup of coffee. Staff interviews did confirm stains on R1’s clothing around the suspected time of incident. R1’s blistered was treated by their Hoag at Home Hospice Nurse on November 29, 2024, who reported the blister had green drainage indicating an infection. Hoag at Home Hospice Nurse denied that any of R1’s underlying conditions could have caused the blisters. Therefore, based on the preponderance of evidence through records reviewed and interviews the allegation that resident sustained a severe burn as a result of neglect is determined to be Substantiated, meaning the complaint allegation is valid and that a violation has occurred. See LIC9099-D for cited deficiencies and immediate civil penalty as per Title 22 Division 6 of the California Code of Regulations. A Civil Penalty is pending determination by Community Care Licensing Division as per Health & Safety Code 1569.49 (f) An exit interview was conducted with Kasan Soewono, Culinary Service Director. A copy of this report, along with LIC9099-D, Appeal Rights, Civil Penalty Assessment-LIC 421 IM and the LIC 811, identifying confidential names were provided and explained.” Per interviews with 2 out of 6 staff stated they give residents medication as prescribed, 4 of the staff members interviewed did not have direct knowledge of medication administration. Regarding the allegation staff did not ensure the resident’s room was cleaned. Interviews with 5 out of 5 residents stated the resident’s rooms are cleaned. Based on interviews with 6 out of 6 staff stated the facility and resident’s rooms are clean. During LPA Mendivil’s initial visit on January 23, 2025, LPA toured the interior of the facility and observed clear and uncluttered walkways and the facility to be free of dust and odors. Therefore, based on the preponderance of evidence through records reviewed and interviews the allegations that staff did not administer medication to resident as prescribed and staff did not ensure the resident’s room was cleaned are determined to be UNSUBSTANTIATED, 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. An exit interview was conducted, and a copy of this report was provided