Complaint·July 8, 2025

Regarding to the allegation of - staff do not ensure that facility is maintained a comfortable temperature, the reporting party stated, R1 was being placed in a temporary room, while the facility replaced the carpet but the heater was broken. According to the sales manager and the interim administrator, the temporary room was vacant for a long time and no one checked the heater prior to R1's move-in as R1 was not supposed to move in to that room, therefore, the facility was not aware that the heater was not working. The interim administrator stated that they called a couple of companies to fix it but they couldn't so they provided a portable heater for R1. LPA interviewed R1 who stated that the temperature of the room was comfortable after the portable heater was provided and LPA observed the room temperature was measured at 73 degrees Fahrenheit. After the investigation, this allegation is deemed to be substantiated. Regarding to the allegation of- staff do not ensure facility vehicle is in good repair, the reporting party stated the facility van has been broken for months and on 4/9/2025, R1 had a medical appointment and R1 had to be transported by the maintenance guy in a personal truck that required R1 to climb into. According to the interim administrator, the facility van was broken on the day of R1's appointment but it has been fixed. The interim administrator stated that the facility provides transportation for residents on Tuesdays and Thursdays, and R1's appointment was on a Wednesday and since the van was broken, the maintenance manager took the resident to the appointment in a private vehicle. The interim administrator stated that she/he was not aware that R1 had to climb into the private vehicle until after the appointment. The interim administrator acknowledged that the facility van breaks down from time to time and when that happens, the facility offers other means of transportation such as vouchers to transportation companies. LPA has completed and substantiated a complaint investigation in November 2024 (reference number 14- AS- 20241121125035) regarding to residents were missing their medical appointments because the facility van was broken. After the investigation, this allegation is deemed to be substantiated. Regarding to the allegation of- director does not have the required qualifications, the reporting party stated that the interim director/administrator doesn't have the qualifications to be in the position. According to the interim administrator who used to be the Health Services Director stated that when the Administrator resigned in February 2025, she was appointed by the Licensee to be the interim administrator. Based on observation and record review, the licensee did not provided any documentation to CCL to update the facility administrator. After the investigation, this allegation is deemed to be substantiated. Regarding to the allegation of- staff do not ensure elevators are in good repair, the reporting party stated that on 5/5/2025, both facility elevators were broken and residents waited downstairs for over 3 hours until one of them was fixed. As part of the investigation, LPA interviewed the sales manager and the interim administrator who acknowledged that both elevators were down on 5/5/2025 and the elevator on the right side has been down for almost 2 years. The sales manager was present on 5/5/2025 and stated that when they learned that the only working elevator was malfunctioned, they contacted management immediately, and call the elevator repair company. The sales manager acknowledged that there were a few residents who were not able to take the stairs so they waited for hours in the dining until the elevator was fixed. LPA completed and substantiated a complaint investigation on 3/11/2025 (complaint reference number 14-AS-20250110144222) regarding to Licensee did not ensure facility elevators were maintained in good repair. After the investigation, this allegation is deemed to be substantiated and a civil penalty of $250 is being assessed for repeat violation. Based on interviews, observation, and record reviews during the investigation, the preponderance of evidence standard has been met. Therefore, this allegation was 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 additional civil penalties. Report was discussed with the interim administrator; a copy is provided with Appeal Rights. Regarding to the allegation of - staff do not ensure resident's showering needs are being met and staff do not ensure resident's incontinence needs are being met, the reporting party stated that there is a resident on the first floor near the elevator that doesn't shower, and smells like urine. The reporting party stated that everyone knows who this resident is, and staff just say this resident doesn't like to shower. As part of the investigation, LPA interviewed the interim administrator who stated that resident #2 (R2) has a history of refusing shower and did not allow facility staff to assist with incontinence care and cleaning the room but R2 is no longer refusing after many conversation of encouragement. The interim administrator reported that the odor is not as strong since R2 has been showering weekly, allowing staff to assist ADLs, and weekly housekeeping and laundry service. LPA attempted to interview R2 but was not successful. LPA interviewed staff #1 (S1) and staff #2 (S2) and both of them reported that R1 is no longer refusing care, R2 has been showering weekly, managing his/her own incontinence care, and allowing staff to assist with laundry and housekeeping services. During LPA's visits on 5/14/2025, 7/3/2025 and 7/8/2025, LPA did not observed any odor by the entrance, by R2's room and the lobby area. This observation was reported to CCL in 2024 and at the time, the facility has provided documentation to proof that the facility implemented different interventions to encourage R2 to participate in care. After the investigation, this allegation is deemed to be unsubstantiated. Based on observation, interviews and records review, these allegations are deemed to be unsubstantiated. Although the above allegations 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 review with the interim administrator and a copy is provided