Complaint·October 24, 2024

Interviews with 9 residents indicated that all require assistance with incontinence care and showering. 7 out 9 residents reported being left in soiled incontinence briefs for approximately three to seven hours, stating that staff are aware of their condition but do not provide the necessary assistance. In addition, LPA Pascua conducted 3 unannounced visits on 07/16/2024 at 1:30pm to 5:00pm, 09/19/2024 at 10:00am-5:00pm, and 10/18/2024 at 6:30am-11:00am. During these visits, LPA Pascua observed a strong urine smell in consistently detected in hallways 2 and 3. Based on interviews and record review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard ha s been met. This deficiency is addressed on the complaint investigation dated 10/24/2024 and a plan of correction has been established. Therefore, there will not be a 9099D page for this substantiated finding. Allegation: Facility staff did not provide showers It was alleged that staff did not shower residents in care. During the course of this investigation, this LPA reviewed facility documentation, and conducted staff and resident interviews. Interviews were conducted with 9 staff members, 5 of 9 who reported that they provide showers for residents. However, they noted instances where other staff claimed to have given showers or attempted to do so, but the shower logs indicated that residents had refused. Additionally, 5 staff members mentioned that many residents often complain about not having received a shower in the past week or are unsure of when their last shower took place. In a separate interview with 9 residents, 7 reported that they do not receive regular showers, averaging only 2 showers per month. In contrast, 2 residents stated that they do not have any issues accessing showers. The LPA also reviewed the facility’s AM and PM shower schedule, which showed that residents are scheduled for full showers two to three times a week. Based on the information gathered, the staff did not shower residents in care. Based on interviews and record review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met. This deficiency is addressed on the complaint investigation dated 10/24/2024 and a plan of correction has been established. Therefore, there will not be a 9099D page for this substantiated finding.An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit. This deficiency is addressed on the complaint investigation dated 10/24/2024 and a plan of correction has been established. Therefore, there will not be a 9099D page for this substantiated finding. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit. On June 24, 2024, the new AC unit was delivered and installed by the vendor, with confirmation that it was operational. The final invoice for the AC unit was paid on July 8, 2024. Interviews with nine residents confirmed that the air conditioning had been fixed and that portable units were provided while the main system was down. Three of the nine residents noted some discomfort but found it manageable with the portable units, while six reported no issues at all. A review of invoices from Wallace Heating and Air and Home Depot confirmed the purchase and installation dates of the new AC unit. The facility's Temperature Log showed that from July 2024 to the present, the temperatures in resident bedrooms remained between 71-75 degrees. Additionally, temperature readings taken in ten resident bedrooms indicated temperatures between 70-74 degrees. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff did not ensure that residents are fed It was alleged that staff did not ensure that the resident’s are fed. During the course of this investigation, this LPA reviewed facility documentation, conducted observations, and conducted staff and resident interviews. Based on interviewed conducted with 9 staff. All 9 staff members report that they provide meals to residents in their rooms if they prefer not to eat in the dining room. Additionally, snacks are available to residents between meals. None of the staff indicated that residents go unfed. Interviews with 9 residents revealed that all deny not being fed. Five residents expressed a preference for having their meals delivered to their rooms, while four prefer eating in the dining room. All residents reported that their food is served on time. They also confirmed that they can request snacks or access food between meals. During three unannounced visits on 07/16/2024, 09/19/2024, and 10/18/2024, the LPA observed that snacks and food were readily available. Furthermore, the facility has established a café area that residents can access at any time. Based on the information gathered it is unclear if the staff did not ensure that residents are fed. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.