complaint·April 29, 2020

Moreover, a review of the hospice assessment dated September 22, 2019, revealed that R1 required care in bathing, grooming, dressing, hygiene, transferring, toileting, and medication management. Physician’s Report dated September 19, 2019, notes R1 as bedridden, which means a person who requires assistance with turning or repositioning in bed. The report indicated that R1 required continuous bed care, a record of skin breakdown, and assistance with toileting, bathing, grooming, dressing, and medication management. The facility's pre-assessment, dated September 20, 2019, showed that the facility was aware that R1 required assistance with repositioning, as the assessment showed that R1 would be assisted with bathing, grooming, hygiene, toileting, transferring with a Hoyer lift, repositioning, and medication management. In further support, on October 7, 2019, hospice documented that they held a case conference with the licensee to discuss R1’s care needs, to include informing the licensee of the importance of repositioning R1 every two hours. Also, hospice nursing notes dated October 12, 2019, revealed that R1 was found soiled in their clothes with a large amount of bowl movement. Although the pre-assessment appraisal and supporting documentation such as the Physician’s Report and hospice plan all confirmed R1 required repositioning every two hours and incontinence care, on October 17, 2019, the licensee updated R1's assessment, in which the plan confirmed that the facility would not provide overnight care from 08:00 PM to 08:00 AM. Investigation revealed the R1’s responsible party did not agree with the new assessment as it did not meet the resident’s needs and it noted that R1 was non-ambulatory; although, the physician had deemed R1 as bedridden. Hospice staff were interviewed by the LPA and their interviews revealed that on multiple occasions, upon hospice arrival to the facility to perform hospice services, they found R1 soiled in their bowel movement. In addition, hospice interviews also noted that R1 disclosed to them that their needs were not being met by the licensee, as R1 stated that they were screaming for help during the night. An interview with the hospice staff confirmed that on November 11, 2019, they spoke with R1’s responsible party about possible new placement to another licensed facility. Though staff interviews were inconsistent, their interviews confirmed that incontinence care and repositioning was not being provided during the night due to the facility’s employment policy of no wake staff between 10:00 PM to 06:00 AM. Furthermore, a review of hospice nursing notes dated November 08, 2019, showed that hospice staff held a secondary meeting with the licensee. During the meeting, the licensee demanded that hospice provide an overnight nurse as a result of R1 screaming at night to be repositioned. The nursing notes also documented that the hospice medical professional was “unable to reason with owner” (licensee) to meet R1’s needs. Therefore, the hospice agency medical professional notified R1’s responsible party of the outcome of the meeting, in which the responsible party expressed interest in relocating R1 to another licensed Residential Care Facility for Elderly (RCFE) that can meet the needs of R1. On November 16, 2019, R1 was relocated to another licensed RCFE that can meet R1’s needs. In reviewing the facility's Plan of Operation under Care of Bedridden Residents, the plan stated that the facility would develop a plan to address resident's needs, including the need to be repositioned every two hours and daily body checks for skin monitoring. Moreover, facility staff, outside sources, and R1's interviews confirmed that the facility neglected to provide regular overnight care in adherence to the hospice care plan to include repositioning every two hours and R1's incontinence needs due to R1’s documented bedridden status. On November 06, 2019, hospice documented that they prescribed a medication to be given routinely at night. Then, on November 09, 2019, hospice increased the medication dosage to assist R1 with any discomfort. LPA reviewed the facility's medication logs and compared them with the physician's orders. Based on the review of the medication's records, the facility did not administer the routine mediation from November 06, 2019, through November 09, 2019. Hospice records and interviews conducted supported that the medication was prescribed and discussed with the facility on November 01, 2019, November 06, 2019, and November 09, 2019. On November 10, 2019, the medication was discontinued. Based on the Department's interviews conducted, and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegations are SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6), deficiencies are cited on the attached LIC 9099D. An exit interview was conducted with Administrator, Naghibi. The Licensee/Appeal Rights (LIC 9058 01/16) and a copy of this report was provided to Mr. Naghibi via email. A return email or reply receipt from the Mr. Naghibi will confirm receipt of documents. This report is an amended version of the original document that was created on April 29, 2020.