complaint·October 7, 2024

The texts states it will be a second fulltime staff to supervise R1 between 10pm to 6am. The text states the increase would start 2 days after receiving the notice. The text states November would be prorated, December’s rent would be $11,880 (the original $7000 rent plus the one on one fee), and starting 1/1/2024 it would be $13,068 per month. The written rate increase notice reviewed, dated 11/20/2023, states the rate as of 12/1/2023 would be $11,800 per month and as of 1/1/2024 would be $12,980 due to a 10% increase. Based on the information, the facility did not give sufficient notice of rate increases for January 2024. Another concern brought forth was that the facility wanted to increase R1’s rent starting in January by more than 10%. However, Title 22 regulations and health and safety code currently do not have increase caps for RCFEs. Based on the information obtained, the allegation is deemed Substantiated at this time. On the allegation: Facility is not following a resident's care plan. It was alleged that R1 required a one-on-one staff overnight for wandering behavior, so the facility increased R1’s monthly fee in order to provide additional staff in the facility. However, it was alleged the facility did not provide additional staff following the rate increase. A witness stated they did a “stakeout” at the facility from 10pm to 6am and did not see any additional staff go into the facility. LPA reviewed a text message dated 11/21/2023 from the Administrator to R1’s responsible party stating they would be sending a 2-day notice that includes a rate increase to add a second overnight staff to provide supervision at a cost of $4880 per month. The texts states it will be a second fulltime staff to supervise R1 between 10pm to 6am. The written increase states an additional $4800 would be added for “one on one supervision.” Administrator stated R1 was very aggressive and was up most of the night and would go through the kitchen refrigerator and pantry, and had other aggressive behaviors. Administrator stated the one NOC staff could not attend to round on the other residents and properly supervise R1, so they added an extra staff overnight. Administrator stated typically the PM shift stayed an extra 1-2 hours to help the NOC staff, and then Administrator came in around 11pm-12am and stayed until 4-5am after R1 went to bed. Administrator stated R1 did not need a one on one to watch them every second, but rather they just needed a second staff overnight to provide adequate supervision to R1. CONTINUED on LIC9099-C Facility charting notes for December 2023 were reviewed. There were notes from the AM and NOC shifts. NOC shift notes stated on 12/19/2023, R1 was up when the staff got to work, but went to bed at 12:30am and stayed asleep. On 12/20/2023, the notes state R1 came out of their room at 10:45pm to eat dinner, went back to their room at 2am and stayed there. On 12/21/2023, the notes state R1 came out of their room around 10pm and 10:20pm looking for a particular staff. R1 went to their room but kept coming out all night. On 12/22/2023, the notes state R1 was awake when they got to work but went to bed at 11:30pm and stayed asleep. On 12/24/2023, the notes state R1 stayed awake, came out of their room to eat again, and went to sleep at 2am and stayed asleep. Based on the investigation, the written two-day increase for R1 states specifically “one on one supervision,” which was not provided based on Administrator’s interview. Therefore this allegation is deemed Substantiated at this time. Exit interview, deficiencies cited on 9099-D, report given, appeal rights given. On 8/25/2023 they were invoiced for a medication that was $33.97, and wrote a check on 9/2/2023. On 10/1/2023 they wrote a check to cover medication gummies at $27.93 and briefs at $44.50. Administrator confirmed R1’s responsible party did state the VA would pay for the medications and briefs, however the Administrator stated they were unable to access the VA. Administrator stated they told R1’s responsible party that as their responsible party/POA they could access the VA on R1’s behalf and provide the items. However the items were never provided, so Administrator purchased the items for reimbursement to ensure R1 had the medication and care items they needed. 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, therefore the allegation is Unsubstantiated. On the allegation: Facility staff yell at residents. It was alleged a staff yelled at a resident they were not getting any lunch. Multiple residents interviewed stated they were treated “fine,” “well,” “very well,” and said there was no yelling or disrespect. One resident stated a staff was disrespectful. Staff stated they never yell at residents, and treat residents with respect. Administrator stated staff have never yelled or been disrespectful, and they would not tolerate that behavior from staff. A credible witness was interviewed who stated they had never witnessed or heard of staff yelling at the residents, but had consistently heard and/or witnessed staff are rude or mean to residents. Witness indicated one resident stated some staff are kinder than others. Administrator stated one resident does not want to be at the facility so they complain about a lot of things. Based on the information obtained, this allegation is deemed Unsubstantiated at this time, and staff’s disrespectful behavior will be addressed on complaint 29-AS-20240715084408. On the allegation: Facility staff did not ensure that a resident's clothing was free of stains. It was alleged R1 spilled food on a new jacket, and it had not been washed but R1 continued to wear the jacket. Administrator confirmed that R1 had very aggressive behaviors, and often refused care verbally and by hitting and kicking staff. Administrator stated R1 had one jacket and wore it often. Administrator stated they tried to wash the jacket but R1 would refuse to allow staff to take it off or launder it, in similar way that R1 refused showers. One time, R1 went outside in the heat and removed their jacket and left it on the patio, so the housekeeper took it and washed it. A credible witness interviewed stated they have not heard of any issues regarding laundry, and have not observed any stained clothes. Administrator stated R1’s behaviors were conveyed to R1’s responsible party. Based on the information obtained, the allegation is deemed Unsubstantiated at this time. Exit interview, report given.