complaint·January 12, 2026

R1 received podiatry care approximately every two months for a total of four podiatry visits. For reasons that could not be ascertained R1 did not receive any podiatry care after those visits. Interviews revealed that all residents were to receive podiatry care from the identified outside provider unless alternative arrangements had been made. There was not evidence that alternative arrangements were made for R1’s podiatry needs. The investigation did not reveal any evidence of R1 receiving any podiatry care for the last year of R1’s residency in the facility. The investigation revealed the condition of R1’s feet at the time R1 moved out of the facility was consistent with a lack of podiatry care to meet R1’s foot care needs. This condition was the result of the facility’s failure to arrange such care. The allegation is SUBSTANTIATED. A deficiency is cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Karen Moran, LVN Cognitive Entrenchment Director a copy of this report and Licensee's Rights (LIC9058) were provided. It was also alleged that facility staff did not keep facility free from incontinence odor. Interviews with internal and external sources and LPA observations did not reveal any concern about odor in the facility on a regular or ongoing basis. This allegation is unsubstantiated. Based on the evidence obtained during the complaint investigation, the above allegations are UNSUBSTANTIATED, meaning the preponderance of evidence standard was not met. An exit interview was conducted with Karen Moran, LVN Cognitive Entrenchment Director , a copy of this report and Licensee's Rights (LIC9058) were provided.