Complaint·July 18, 2023

A finding that the complaint is UNFOUNDED means that the allegation was without a reasonable basis. Therefore, the above allegation is dismissed. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Melanie Niez, along with a copy of the appeal rights. The larvae were extracted and R1 was transported back to the facility to continue wound care and home health care. On 10/21/22 R1 was transported to the hospital, small maggots were found in R1’s surgical wound. The surgical wound had developing larvae and maggots due to R1 refusing skin treatment after the surgical procedure in 2021. R1 received wound care from a wound company six (6) days a week to monitor R1’s surgical wound as best as possible with the refusal of medical care from R1. R1 was scheduled to have follow up appointments with the hospital and specialists to ensure the surgical wound was taken care of appropriately. During an interview with the facility administrator, the administrator stated that R1 had a medical procedure in 2021 that developed into a wound. The administrator was notified by staff that R1’s surgical wound had maggots in it during September of 2022 and October of 2022. The administrator was unsure how the maggots developed. The facility does not provide wound treatment for R1. The wound treatment is provided by an outside wound care company and by home health. The facility was responsible for “keeping an eye” on R1’s surgical wound and notifying wound care if they observed additional care was needed. If an observation was made, it was documented in R1’s communication log. During interviews with the facility staff, the staff stated that R1 had a medical procedure that developed into a wound. R1 had an outside wound care company and home health coming into the facility to provide wound care. The facility staff denied being responsible for the care of the wound. The facility staff was instructed to contact the outside providers if the bandage came off or became soiled. If there was facility staff that was an LVN, they were allowed to change the bandage in between the outside providers facility visits. It was noted that there were times when R1 would “pick at” the wound, “fidget at” the wound, and remove the bandage. There was an instance, on an unknown date, when a staff member observed that the bandage had fallen off and maggots were witnessed. The facility staff informed the administrator, and they were informed to call non-emergency services. Emergency medical services arrived at the facility, and R1 was taken to the hospital for treatment. During the home health nurse interviews, the nurses denied that the wound was a pressure injury. The home health nurses stated they were providing wound care to R1 five (5) times a week and an outside wound company provided wound care one (1) day a week. The nurses stated that R1’s wound was not healing. It was noted that the bandage had a hard time saying on R1’s face due to the wound being close to R1’s hairline. Due to this there was a slight bandage opening. It is possible that the opening is how the maggots developed, but there is no way to know for sure. There were times when R1 removed the bandage, or it fell off. R1 was reminded not to touch the bandage. On 10/21/22, a home health nurse observed maggots in the wound and informed staff to call the non-emergency services. Based on evidence obtained, the allegation listed above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Melanie Niez, along with a copy of the appeal rights. During interviews with the staff, the staff stated that the residents’ bedrooms are cleaned weekly. If a resident requests additional cleaning, the staff will clean the resident’s bedroom in between the next scheduled cleaning. The main areas of the facility are cleaned once a week. If a main area needs to be cleaned more than once a week, the staff will clean the area in between the weekly cleaning. For allegation, Facility staff do not ensure that resident hygiene needs are met: During interviews with residents, the residents either shower on their own, or have the staff assist with showering. The residents did not have any concerns about their hygiene and showering needs. During interviews with staff, the staff stated that the facility has a caregiver that strictly does the showering for the residents. The caregiver follows a shower schedule, so the residents are showered on a regular basis, unless a resident refuses a shower. During document review, LPA reviewed the shower schedule for the residents. The shower schedule details which residents receive shower assistance and how often they receive assistance. The schedule differs for each resident based on their individual care needs. For allegation, Facility staff do not ensure that resident's toileting needs are met: During interviews with residents, the residents stated that their diapers were changed appropriately and there were no issues with the time frame staff provided toileting needs. During interviews with the staff, the staff stated that the residents’ diapers are changed multiple times throughout the day. At minimum, diapers are checked when residents wake up in the morning, before breakfast, after breakfast, before lunch, after lunch, before dinner, and before bed. If a resident needs an additional diaper change, the residents can use their call button and a staff will come to change their diaper. The staff stated that they have not had any complaints from the residents regarding their toileting needs. For allegation, Facility staff do not respond to resident's call for assistance in a timely manner: During interviews with residents, the residents stated that there were no issues with the staff responding to their calls for assistance. The average amount of time a resident waited for a staff member to arrive is five (5) to ten (10) minutes. During interviews with staff, the staff stated that they respond to the residents’ calls within five (5) to ten (10) minutes. For allegation, Facility staff do not adequately supervise residents in care: It was alleged that a resident was left unsupervised where they got into trays of partially eaten food. During document review, LPA reviewed the facilities LIC 500 and their staffing schedule. The facility has staffing to care for the residents throughout the day. During interviews with residents, the residents stated that staff are always present to help them when needed. The residents did not have any concerns about food trays being left out for extended periods. During interviews with the staff, the staff stated the only time food trays were left outside of the resident’s bedrooms was when a resident was in isolation due to medical concerns. The trays of food were placed outside the door when a resident was done with their meal and picked up by the housekeeping staff as soon as the meal was completed. The staff was not aware of any situations where a resident ate food that was left on the floor. Based on evidence obtained, the allegation listed above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) was discussed and provided to Administrator Melanie Niez, along with a copy of the appeal rights. During interviews with staff, the staff stated that the facility smells like urine and bowel movement. The staff has tried to use different types of cleaning agents and cleaning techniques, but the smell is still present after cleaning. The staff stated that they believe the smell is penetrated into the flooring and carpet throughout the facility. Based on evidence obtained, the allegation listed above is deemed SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because of the preponderance of evidence the standard has been met. During today’s visit, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D were discussed and provided to Administrator Melanie Niez, along with a copy of the appeal rights.