Complaint·April 6, 2023

According to SFDPH Nurse, the facility did not report any staff members who tested positive within the outbreak time-frame above. Based on the facility's internal COVID-19 positive case linelist, there was staff members listed, however based on the linelist that was provided to CCL and SFDPH, there was no staff listed. After the investigation, this allegation is deemed to be substantiated as the facility failed to notify families, CCL and Local Public Health Department when facility staff tested positive for COVID-19 as directed by Provider Notification Notices (PIN)s including but not limiting to PIN 20-02-ASC, PIN 20-04-ASC, and PIN 20-13-ASC. Based on interviews and record reviews during the investigation, the preponderance of evidence standard has been met. Therefore, this allegations were determined to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Report was discussed with the asst. general manager, administrator and building engineer. A copy is provided and appeal rights. Regarding to allegation of staff did not ensure that resident was eating, the reporting party stated that resident #1 (R1) tested positive for COVID-19 and staff did not ensure R1 had adequate meal intakes and R1 appeared to have weight loss. As part of the investigation, LPA interviewed residents, and facility staff who were assigned to care for residents that tested positive for COVID-19. LPA interviewed 4 facility staff including one who cared for R1 and all of them reported that they assisted resident with their meal services including taking their meal orders, assisting with their meals, checking with them while they were eating, and cleaning up after they were done, placing all the used disposable items into the brown bag and trashing it in the garbage bag. According to the staff #1 (S1) who was assigned to R1, R1 did not have an appetite couple of meals during R1's isolation period so S1 offered R1 alternate food items and encouraged R1 to consume it and drink liquid to stay hydrated. LPA interviewed 2 residents who tested positive during the most recent outbreak and both of them reported that staff assisted them with their meals, cleaned their rooms and provided assistance to their personal needs. After the investigation, this allegation is deemed to be unsubstantiated. Regarding to staff did not ensure that resident received their mail in a timely manner, the reporting party stated that on the facility's website, it advertised that mail would be delivered daily. However, R1 did not get the mail delivered, instead, R1 went to retrieve it and when R1 was not able to do so in December 2022, facility staff did not deliver it to R1 until Jan 2023 which resulted R1 missed Christmas mail greetings from R1's loved ones and other communication from the facility. As part of the investigation, LPA interviewed facility staff, residents and responsible parties. According to facility staff, resident's mails are being delivered to them by the concierge unless a resident preferred to get it by themselves. LPA interviewed 2 residents and both of them reported that their mails are being delivered by facility staff unless they were waiting for an important package and/or a mail then they would go and get it by themselves. According to responsible party, their loved one's mails are being delivered by facility staff but sometimes their loved one enjoyed going downstairs and retrieved it by themselves. After the investigation, this allegation is deemed unsubstantiated. Although the above investigations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. This report is reviewed and discussed. A copy is provided. Regarding to allegation of staff did not follow COVID-19 quarantining/isolation protocols, the reporting party stated resident #1 (R1) tested positive for COVID-19 and did not completed the full course of 10-day isolation as R1 was out of isolation on day 8 after testing negative. As part of the investigation, LPA interviewed facility director, facility staff, responsibility parties and residents. The facility director denied the allegation and stated that all the residents who tested positive completed their 10-day isolation period even they tested negative prior to the 10-day. LPA interviewed 4 facility staff who were designated to care for positive COVID-19 residents including a staff who cared for R1 during the outbreak and all of the stated that their residents were on isolation for 10-days. LPA interviewed 2 residents and 3 responsible parties to residents who tested positive for COVID-19 and all of the reported that they or their loved ones were in isolation for 10-days. After the investigation, this allegation is deemed to be unfounded. This agency has investigated these complaints and we have found that the complaints were unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This report is reviewed and discussed. A copy is provided.