Complaint·December 12, 2023

The investigation revealed the following. Regarding Allegation(s): Facility is in disrepair- It is alleged the facility is in disrepair. LPA Ramirez conducted both interior and exterior tour of facility plant. LPA Ramirez did not observe facility to be in disrepair during visit. Four (4) out of the four (4) staff interviewed deny this allegation. Two (2) out of the two (2) residents interviewed deny this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Facility staff failed to properly administer resident’s medications- It is alleged facility staff are not properly administering medications to residents. LPA Ramirez reviewed and compared five (5) out of six (6) residents medications administration records (MAR) for the month of December 2023, to five (5) out of six (6) residents’ prescriptions and Centrally Stored Medications and Destruction Record (LIC 622). Resident#6 (R6) was out of the facility and medications were not available. LPA Ramirez did not find any irregularities during records review. Four (4) out of the four (4) staff interviewed deny this allegation. Two (2) out of the two (2) residents interviewed deny this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Facility is not adequately staffed- It is alleged the facility is not adequately staffed. LPA Ramirez observed S3 and S4 providing care and supervision to five (5) out of the six (6) residents. Four (4) out of the four (4) staff interviewed deny this allegation. Two (2) out of the two (2) residents interviewed deny this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Facility failed to maintain a complete and accurate resident’s records- It is alleged the facility failed to maintain a complete and accurate resident's records. LPA Ramirez reviewed of six (6) resident records (R1-R6) and did not observe any irregularities or deficiencies to cite. Four (4) out of the four (4) staff interviewed deny this allegation. Two (2) out of the two (2) residents interviewed deny this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview conducted. A copy of this report and appeals rights was provided. Facility failed to maintain a complete and accurate staff records- It is alleged the facility failed to maintain a complete and accurate staff records. LPA Ramirez reviewed three (3) personnel records, out of the four (4) staff present at the facility. During records review, LPA Ramirez discovered two (2) out of the three (3) records reviewed, were missing documented annual training per 1569. 625 (b)(2) in their personnel record. Based on review of documents and interviews conducted, the preponderance of evidence standard has been met, therefore the above two allegations are found to be SUBSTANTIATED. Deficiency is being cited. Exit interview conducted. A copy of this report, 9099-D and appeals rights was provided.