Follow-up on corrections·January 24, 2024

On 1/24/2024 at 11:30am, Licensing Program Analyst (LPA) Arvin Villanueva arrived at this facility unannounced to conduct a case management visit. During the course of the investigation in to complaint control number 27-AS-20230712160817, another deficiency was identified which is being addressed by this case management. LPA Villanueva met with Taty Sael, Administrator, and explained the purpose of the visit. During today’s visit, present were 3 residents in care with 2 staff on duty. During the course of the investigation for above listed complaint, file reviews were conducted. A review of R1’s care notes dating 07/02/23 indicates R1 “started coughing lastnight…saying she cannot breath…, 07/03/23 R1 did not have a good nights sleep lastnight, 7/07/2023 indicates that R1 was having difficulties sleeping the past 3 nights due to coughing. Additionally, R1 was noted to have hard time breathing with O2 level measured at 65. It was also noted that the administrator found R1’s right lower arm to be swollen and red/bluish. Administrator notified clinic physician via phone and was ordered Albuterol nebulizer increased to 6 times every 4 hours as needed. Also prescribed cough syrup 4 times daily and antibiotic to start on this date. Further review of R1’s care notes dating 7/9/2023 indicates that R1’s right arm (dialysis port) continues to be bleeding. It was noted that care staff did not change the dressing on the wound. On 7/10/2023 of the care notes, it was noted that care staff notice R1’s nose to be bleeding and a bruise on the corner of R1’s mouth was noted. It was also noted that R1’s physician was notified and a plan to send R1 to the hospital due to bleeding on R1’s nose and dialysis port. L PA cannot confirm from the R1’s note if R1 was sent to the hospital. By this time, R1’s condition appeared to have worsened. Although a physician was contacted on 7/7/2023 and medications were prescribed, the licensee did not ensure timely medical attention for R1 due to R1’s breathing problem with O2 stat level at 65. Additionally, R1’s change in condition worsened on 7/10/2023. {Con't to LIC809-C} {Con't from LIC809} During a review of R1's care notes, LPA Villanueva read that R1 was sent to emergency hospital on the following dates: 8/24/22, 2/22/23, and 3/23/23. Per interview with the administrator, incident reports on these incidents were not reported to the Department. The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. An immediate civil penalty in the amount of $500 is assessed in addition to the citations issued. This incident is currently under review and a future civil penalty may apply based on 1569.49(f) H&S. Failure to correct the deficiencies may also result in civil penalties. An exit interview was conducted with Taty Sael, administrator and a copy of this report and appeal rights were provided.