Follow-up·May 10, 2023

On 5/10/23, Licensing Program Analyst (LPA) Kevin Mknelly, met with Kelly Smitley to follow-up on an earlier case management visit on 4/27/23. Upon entering the facility, analyst completed electronic screening and sign in. Analyst followed facility's policy and wore a surgical mask. The incident reports discussed were submitted to the regional office on 4/14/23, 4/22/23 and 4/25/23. The report submitted on 4/14/23 was for a resident to resident incident of aggression of R1 toward R2. The report stated that on 4/13/23, (R1) “suddenly approached (R2) and slapped her on the face, grabbed her right shoulder and dragged her on her side.” Records and statement found R1 to have dementia and to be a resident in the memory care section of the facility with R2. There was no prior history reported to LPA of aggressive behavior by R1 toward other residents. The report submitted on 4/14/23 by Aegis LVN, S1, stated that “suggested 1:1 caregiver for (R1) and DPOA agreed.” On 4/27/23, Administrator stated to LPA that 1:1 caregiver resources were being sought through an agency and that the 1:1 services began for R1 on 4/26/23. The report submitted on 4/22/23, by S1, was for a resident to resident incident of aggression of R1 toward R3 occurred on 4/21/23. The report submitted by S1 for the 4/21/23 incident stated (R1) “ came to (R3) at her table and suddenly slapped and punched her on the left side of her face.” Facility evaluation of residents involved found no injuries to residents. As the identified 1:1 caregiver identified as needed for R1 was not established between 4/13/23- 4/26/23 for their aggressive “sundowning” behaviors, and a second aggressive incident occurred during that time, the licensee failed to insure there is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified as defined in CCR 87705(c )(4). Furthermore, LPA conducted additional reviews to staff working during the reported loss of money belonging to R4, sometime between the period of 4/20/23 for an upcoming outing. On 4/22/23 the money belonging to R4 was found to be missing. To date, the money has not been recovered and no witness to a theft have been found. However, on 4/21/23 and 4/22/23, staffing agency contracted staff, S2, was present and assigned to assist R4 and other residents. A criminal records clearance review of staff present at the facility found S2 to not have a criminal background clearance on file with the Department of Social Service. The agency that employed S2 and who contracted with the licensee is a staffing agency and not a home care organization. Nor were records found that S2 is a registered home care aid. Residency agreements state- person who provides client assistance in dressing, grooming, bathing, or personal hygiene. care, toileting, transferring and similar care must be provided by our staff. The licensee failed to ensure that any person who provides client assistance in dressing, grooming, bathing, or personal hygiene had undergone criminal record clearance as identified in Health and Safety Code 1569.17(b)(1)(C). S2 had worked at this facility greater that 5 days. Lastly, documents presented to LPA by the Administrator on 4/27/23 as well as a phone conversation with a representative of the staffing agency for whom S2 was employed found that only verification of mandated reporter training was on file for S2. The representative from the staffing agency confirmed that they are not aware of RCFE staff training Citations and civil penalties are therefore issued. Report was reviewed with the Director and copy of the report and appeal rights provided.