complaint·October 1, 2025

The Director of Nursing reported that all residents are showered at least twice a week, but some residents require 3 showers a week and they are provided as needed. It was reported that R1 was not provided their incontinent briefs (briefs). 3 out of 5 staff reported that sometimes residents, including R1, take them off. 5 out of 5 staff reported that they attempt to have the residents put the briefs back on. 5 out 5 staff interviewed reported that they never force a resident to wear something they don’t want to wear. The Director of Nursing reported that they do their best to keep residents dressed but sometimes residents want to change their clothes or put something else on, and staff are instructed to assist residents and to make sure they are wearing clean clothing. 5 out of 5 staff interviewed denied the allegation and reported that all of the residents are being properly cared for. None of the evidence gathered supports the allegation therefore the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. The investigation into the allegation, staff did not safeguard residents personal belongings, revealed the following. It was reported that Resident 1’s (R1’s) bed sheets, hair dryer, handbag, clothes and coat went missing. No other specific details were provided. The Executive Director and Director of Nursing reported that no missing items were reported. 5 out of 5 staff members interviewed reported that they were unaware that R1 had any missing items. 5 out 5 staff reported that if a resident has missing bed sheets they replace them. The Director of Nursing reported that some residents provide their own sheets and all laundry for each resident is done separately so nothing goes missing. The Director of Nursing reported that if a resident’s sheets are being washed, clean sheets will be provided by the facility until their sheets are laundered and ready to be put on the resident’s bed. A review of R1’s inventory list shows R1’s responsible party declined to have any of R1’s property inventoried at the time of move in. It is unknown what items R1 moved in with and had in their possession. None of the evidence gathered supports the allegation, therefore the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided. Based on the evidence gathered, the preponderance of evidence standard has been met therefore the allegation is substantiated. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.