Complaint·October 11, 2022

9099C(1)..Resident (R1) moved into the Memory Care Unit of the facility on/around August 10, 2021 from a skilled nursing facility. Resident’s physician’s report, dated 7/29/2021, indicates resident has a diagnosis of Dementia, Type 2 Diabetes, has auditory impairment, is able to participate in bathing and needs assistance with toileting. Allegation: Resident did not receive a shower chair for a long period of time. Complaint states that resident did not receive a shower chair for months. Staff interviews revealed that resident had a shower chair upon moving into the community in August 2021 and that the chair actually belonged to resident's roommate but she was able to use it. Fax communication to resident’s physician, on 9/26/2021, notes resident had a “guided fall” while being assisted in the shower as resident was sliding down in the chair when she began screaming and kicking staff members. Staff interviews also indicated that when resident moved to another room on/around March 2022, she did not have a shower chair to use for a while and so staff had to try and shower resident while she was in her wheelchair. Another staff state d that she saw a chair in resident's personal shower at one point but then it disappeared, so she checked in the laundry room and the chair was not there. A third staff stated on 5/24/22 that staff was "still trying to get the doctor to fax an order- she is not using one that I know of". Physician Fax reports show a request for an order was made for a shower chair on 4/19/2022 and 4/27/2022. A fourth staff stated resident was "always scared to stand up" and she had a chair and "we used her wheelchair " also and sometimes it took (2) of us to shower her. Staff stated resident got a shower chair in September 2022. Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- Allegation: Resident developed a rash while in care. Complaint alleges client has rashes on her breast and stomach and smells very bad. All staff interviewed indicated that resident was challenging to give a shower to and would often resist staff trying to bathe her. Several staff stated that resident would go weeks without a shower due to not liking the water with one staff stating " she never got showered" and "constantly had a rash under her breast". cont on 9099C(2).. 9099A-C(1)...Resident care notes from 8/13/2021 indicate resident was sent out to the hospital for further evaluation of her chronic back pain and sacral ulcer. Discharge papers show resident returned to the facility the same day with pain medications and information about preventing pressure injuries. Home health records show on 8/14/2021 resident was treated for a Stage 2 pressure ulcer on mid upper buttocks and complaints of mild pain and was seen again on 8/21/2021 for continued wound care to Stage 2 and for a Stage 1 on the right heel. Resident received a prescription for Calmoseptine ointment on 8/24/2021 to be applied twice daily until healed, was seen again on 8/27/2021 to assess and instruct regarding existing (2) wounds and was discharged on 9/3/2021 with wound care instructions of “frequent position changes, continue applying moisture barrier cream with incontinence skin care”, noting resident had a “Stage 2 inner gluteal pink skin, not open with flaky skin”. Physician's fax report sent on 4/15/22 by a prior MCD to resident's primary care physician at the time, states, in part staff has noticed an increase in redness and some small open areas forming .. we continue to use the calmoseptine in those areas but little to no effect" and resident is in pain and agitated.. Physician's response received on 4/18/22 states resident has an order for Norco already and to add Tylenol twice daily. An antibiotic treatment of 14 days was prescribed on 4/20/22. MAR documentation shows Amox Clav 875-125 mg tablets were given for 14 days, starting on 4/21/22 through 5/4/22 and Clotrimazole-Betamethasone creme was applied twice daily, for 20 days starting on 4/27/22 in the evening. Physician's fax report sent on 5/9/22 describes resident to have (2) open sores in her groin area and (2) that are bleeding and physician's fax report sent on 5/19/22 reports resident has "redness, bumps and peeling under both breasts" and requests another order for Clotrimazole-Bethamethsone cream as the 20 days has finished. Resident was sent to the emergency room on 5/20/22 and received a prescription for Nystatin topical powder and Keflex capsule. MAR shows Keflex was administered 3 times daily for 7 days, as prescribed, effective 5/21/22; however, resident did not receive the prescribed cream on 5/17/22 due to needing a refill. A new order was written on 5/24/22 but was not given on the evening of 5/30/22 and on 5/31/22 due to waiting for a medication delivery. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED. cont on 9099A(C2).. 9099AC(2).. Allegation: Staff did not seek medical attention for resident. Complaint alleges that a Med-Tech falsely documented that client has already seen a doctor regarding the issue of rash from head to toe. LPA reviewed multiple Physician's Fax Reports dated 4/15/22, 4/19/22, 4/27/22, 5/4/22, 5/6/22, 5/9/22 noting different facility staff reported to resident's physician that resident had pain, redness and swelling in groin/buttocks to be worsening. some areas appear to be pealing, bumps have appeared on her arms and body, complaining of lower abdomen pain during urination. Many staff stated that resident's physician was difficult to get in contact with as well as resident's conservator. Staff stated that when resident's physician did respond, she indicated she needed to see resident in person. Fax physician report dated 4/27/22, reads "Please make appointment to see PA (Physician's Assistant)". Resident was sent to the Emergency Department on 4/19/22 and 5/19/22 and was not seen by her primary care physician at the time. Resident's conservator authorized the facility's concierge physician to begin seeing resident on/around June 2022. Documentation reviewed for June 2022 and forward show the facility received a timely response and resident was seen by the physician when reaching out. It was not able to be determined by documentation if a Med-Tech falsely documented that resident had seen her physician to treat the rash. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. 9099C(2).. Physician’s fax report dated 12/25/2021 notes while toileting resident, staff “noticed a large hand sized patch of blotchy red skin under her left breast… and a dime sized bump” not previously seen before. A prior MCD stated “ the rash was "on her arms and thighs" , and "the rash did improve with bathing". The prior MCD commented it is "definitely a fungal rash" and also “she had a yeast under her breast”. Another MCD stated that resident resident enjoyed the jacuzzi and would sometimes cooperate better with staff than when trying to bathe her in the shower. A caregiver staff confirmed on 5/24/22 that resident did go to the ER "because of the rash" as the the NOC shift Med-Tech said resident was complaining off pain and the rash was "itchy and burning". LPA reviewed note from resident's physician, written on 6/17/22 following visit on 6/8/22 , which says “perineal rash is likely a fungal dermatitis due to poor hygiene (wears Depends) and her poorly controlled DM (Diabetes Mellitus)". Physician's report, dated 9/8/22, says resident has dermatitis associated to incontinence. Current MCD stated on 9/22/22 resident's rash " is better and staff is still using creme". MAR documentation shows Menthol-Zinc Oxide ointment, or Calmosepine ointment, was prescribed on 12/14/2021 and was administered starting on 9/8/22, for the month of September, when resident returned to the facility. A prior MCD indicated that resident would refuse showers regularly and she "finally got her to take one" and resident "would scream and scream" in the shower when the water started. Staff interviews confirmed that if a resident refuses on a regular basis, not all staff will try and redirect the resident to be able to give the shower. LPA finds this allegation to be SUBSTANTIATED. Allegation: Resident's hygiene needs are not being met. Complaint alleges client has only been showered 3 times in the past 4 months. One staff stated resident was not showered the entire month of Sept and went 6 weeks without shower. Another staff s tated "the challenge is she resists, she needs a 2-person assist and she would scream "don't touch me". A third staff stated she and another staff gave resident a shower recently and it was difficult", stating "it's extremely hard to care for (R1)" and she is "definitely a 2-person assist" for the last year. A fourth staff stated "she never really wanted to shower" and she would refuse and went weeks without receiving a shower" and "some of the caregivers on the NOC shift gave her a shower because they couldn't stand seeing her unshowered for so long. Several staff stated they would report to the lead- Med-Tech, verbally that resident was not showered and nothing was done. 9099c-(3) 9099C(3).. An additional staff confirmed on 5/24/22 that "resident does not like showers and throws herself on the floor", stating that she "believes that no matter the time of day or which caregiver, (R1) won't cooperate with showers. Last week we were able to give her a shower on the NOC shift. Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulation, Title 22, Division 6, Chapter 8, the following (2) deficiencies are cited on the 9099D pages. Exit interview. Copy of report provided with appeal rights.