Complaint·December 22, 2023

INVESTIGATION REVEALED THE FOLLOWING: Allegation #3: Facility is not adequately staffed. It is alleged the facility is operating with inadequate As a result of the complaint, the complainant was concerned that the facility operates with a minimum number of staff. On 12/12/23 between 3:03 pm – 5:59 pm, the Department interviewed (2) out of (2) staff #1-#2 (S1-S2) revealing there are two caregivers for supervision to five residents during shift 7:00 am through 7:00 pm. (S1-S2) stated an “awake” staff in place to work overtime when any residents post restlessness behavior or incontinent assistance. Service records revealed residents #1 and #2 (R1-R2) are diagnosed with dementia. On 12/22/23 between 8:30 am - 9:24 am the Department reviewed resident #6 (R6) who was admitted on 12/16/23 and requires continuous bed care, bowel & bladder Impairment, and unable to evacuate according to (R6's) Physician's Report (date 12/14/23). (R1) diagnosed with dementia requires observation/night supervision and is not able to self-evacuate, needs assistance with toileting, and a fall risk according to (R1's) Pre-placement Appraisal Information LIC 603 (date: 07/20/23) Appraisal/Needs Services Plan (date: 07/28/23), and Physician's Report LIC 602 (date: 07/13/23). (R3 and R5) both are hospice residents. (R3) is bowel & bladder Impairment, who cannot self-evacuate, and requires observation/night supervision according to (R3's) Physician's Report (date: 07/30/23) and Resident Appraisal LIC 603 A (date: 07/30/23). (R5) is bed bound, has seizures, a falls risk, requires maximum (ADL) assistance, and is unable to self reposition according to (R5’s) Physician’s Report (date: 01/19/22). Based on the gathered information, there is sufficient evidence to support the allegation mentioned above. The facility requires a permanent night staff for care and supervision for (4) out of (6) residents. Allegation #4: and Facility failed to maintain complete accurate resident records. The details of the complaint alleged that the facility failed to maintain complete and accurate resident records. The complainant was concerned the facility was not operating within Title 22 requirements. (Evaluation Report continues LIC 9099-C) On 12/12/23 between 1:52 pm - 2:46 pm, the Department conducted a review of resident #1-#5 (R1-R5) service files. The review of resident #1 (R1) records revealed to be complete. (R2), (R3), and (R4) did not include a Safeguard for Property Valuables (LIC 621) on file. (R4) was admitted on 11/20/23 and did not include an Appraisal/Needs and Services Plan (LIC 625) and (R5) LIC 625 is incomplete missing page 3 and 4. (R6) admitted on 12/16/23 did not have Identification and Emergency Information (LIC 601). Based on the information gathered, there is sufficient evidence to support the allegation mentioned above. Allegation #5: Facility failed to maintain complete and accurate staff records. The details of the complaint alleged that the facility failed to maintain complete and accurate staff records. The complainant was concerned because the facility was not operating within Title 22 requirements. On 12/12/23 between 3:05 pm - 4:30 pm, the Department conducted a review of staff #1-#5 (R1-R5) personnel files. Upon examination of staff #2 (S2) hired on 07/07/22, file was found incomplete. (S2), did not have Health Screening LIC 503, Employee Rights LIC 9052, Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders SOC 341 and TB Test. (S1), (S3), (S4) and (S5) personnel files were found to be within Title 22 regulations and accurate and complete. Based on the information gathered, there is sufficient evidence to corroborate the allegation mentioned above. Based on observations, interviews, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are cited on the attached LIC 9099-D. An exit interview was conducted with Albert Narez , and a hard copy of the report along with appeal rights. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *