complaint·March 20, 2024

It was also alleged that facility staff did not provide activities for residents. It was reported that when the facility initially opened, licensees were good at providing activities and engaging the residents in activities. After a while, reportedly, licensees took a step back from the facility’s day to day operations; during that time period, activities ceased. Interviews conducted revealed that bingo is conducted periodically, but there is no set schedule, and the occurrences are random. Other than the occasional bingo games, interviews yielded that there are no activities provided for residents to participate in. Accordingly, the above identified allegations are substantiated. This finding means that the preponderance of the evidence standard has been met and the allegations are valid. Deficiencies are cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC 9099-D. An exit interview was conducted with Karina Ramirez, and copies of this report and Licensee/Appeal Rights (LIC 9058) were provided at the conclusion of the visit. Karina’s signature below serves as acknowledgment of receipt of copies of the report and rights. [2] were initiated and discontinued on a few occasions. The investigation yielded that on 8/7/2023, R1 became agitated at the facility and began kicking and punching his/her bedroom windows. Staff attempted to redirect R1 and administered an as-needed (PRN) medication in an effort to address R1’s agitation. According to interviews conducted during the investigation, 911 was called to have R1 transported to the hospital to be evaluated. By the time paramedics arrived, the PRN had taken effect, and R1 had settled down. Paramedics contacted R1’s responsible party and informed the responsible party that it was suspected that R1 may have a urinary tract infection (UTI) and inquired whether R1’s responsible party wanted R1 to be transported to the hospital. R1’s responsible party declined transport of R1 to the hospital, as he/she did not believe it was necessary, since R1 was calm at the time. According to evidence obtained during the investigation, the following day, R1’s responsible party transported R1 to the hospital, and medical records reflect that R1 was diagnosed with a UTI and hypernatremia [deficit of total body water relative to total body sodium level]. R1 was admitted and stabilized at the hospital. Subsequently, R1 was transferred to a skilled nursing facility (SNF) on 8/11/2023, where R1 remained until his/her death on 8/19/2023. R1’s death certificate reflects that the primary cause of death was vascular dementia with contributing factors of urinary tract infection & hypernatremia. According to the Mayo Clinic and interview with medical personnel, lack of appetite and fluid consumption is common for persons with a diagnosis of dementia who are in cognitive and overall health decline. Hospital records that were reviewed indicate that R1’s hypernatremia likely resulted from R1’s diagnosis of dementia and the infection. Evidence obtained during the investigation indicates that R1 continued to consume water, but his/her water intake decreased during R1’s last few weeks at the facility, due to the progression of dementia and decline of R1’s cognitive state. Interviews yielded that, although R1’s fluid (water) consumption decreased, facility staff did not see signs of dehydration or have reason to believe R1 was becoming dehydrated. [3] It was also reported that R1 had an extreme rash with open sores on his/her entire body that had been present for at least ten months and were, reportedly, confirmed by lab results, to be scabies. Medical records reviewed during the investigation reflect that on 6/16/2023, samples were biopsied from two areas on R1’s body to be lab tested to determine the cause of the rash. The records reflect that the results were received on 6/20/2023, and R1’s responsible party was informed on 6/24/2023 that the rash was spongiotic dermatitis, which includes contact dermatitis, atopic nummular eczema, and drug reaction. Interviews and records yielded that facility staff had been applying prescribed medication to the rash. In addition to the foregoing, the investigation revealed that R1’s responsible party repeatedly cancelled or declined appointments that were scheduled for a nurse practitioner from a mobile physician company to visit R1, which prevented R1 from being evaluated by a medically trained professional for conditions such as dehydration and observation of the ongoing rash. The investigation did not yield evidence to conclude that facility staff did not seek timely medical attention or that action or inaction on the part of the licensee caused R1’s death. It was also reported that the licensee did not maintain the facility free of pests. The investigation yielded that there may have been a few occasions when pests were observed in the facility. However, the investigation also yielded that the licensee was taking measures to address any issues with pests by having pest control treatment to occur in the facility. The next allegation is that the licensee did not maintain a clean facility. It was reported that upon removal of the bed of a former resident, dirt and dead bugs were observed where the bed had previously been, and dust was observed in the facility. It was discovered during the investigation that there had been construction work occurring on the facility property, and items were, at times, not stored out of public view, which resulted in the accumulation of items around the facility. [4] During LPA’s unannounced visits, although it was observed that work had been occurring around the facility, inside the facility was observed to be clean. Additionally, interviews conducted did not yield evidence to conclude that the facility was not kept clean. Based on the foregoing, the allegations are unsubstantiated. This finding means that although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted with Karina Ramirez, and copies of this report and Licensee/Appeal Rights (LIC 9058) were provided at the conclusion of the visit. Karina’s signature below serves as acknowledgment of receipt of copies of the report and rights. An exit interview was conducted with Karina Ramirez, and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to her at the conclusion of the visit. Karina’s signature below serves as acknowledgment of receipt of copies of the report and rights.