Complaint·September 13, 2021

Resident has had extreme weight loss Based on staff interviews, 5 out of 5 staff stated that R1 refuses to eat because R1 thinks the food is being poisoned and that the water is plastic. Staff (S1) stated that R1’s MD was notified that R1 is refusing everything including medication. Based on records review, facility informed MD of R1’s refusal to take medication. Facility also reported to MD that R1 stays in bed most of the time, has poor appetite and was choosy with food. S1 stated that per R1’s physician’s (MD) order, R1’s medication is mixed with the food but R1 could taste the medicine in the food and would refuse to eat it. S1 stated that they normally offer R1 the same food as the other residents, sometimes R1 would eat it and sometimes R1 would ask for something else. They would make it for R1 but then R1 would change mind again and ask for something else. R1 would check if they would make it but R1 still wouldn’t eat it. R1 would throw the food on the ground or at the staff. Resident's weight loss not brought to the attention of the resident's responsible person Based on staff (S1) interview, when R1 was admitted at the facility in April 2019, R1 weighed around 240lbs. R1’s spouse was made aware of R1’s condition by the facility and R1’s spouse would visit R1 every weekend until around December 2020 wherein R1 weighs around 150lbs. When COVID-19 happened, R1’s spouse would still visit by R1’s window until R1’s spouse could no longer visit due to a medical condition. S1 stated that R1’s family members (FM) became R1’s conservator since May 2020 but they were not told until the later part of the year. Based on staff (S2) interview, FM is consistently notified about R1's condition, R1's behavior, and R1's refusal to take medications, R1 refusing care and R1 not eating and losing weight. Continued LIC9099-C. Food service is inadequate Based on staff (S1) interview, R1 is not on a special diet and they would serve whatever R1 requests and they would offer R1 snacks too. They would serve the food to R1, sometimes R1 would say OK and eat it and sometimes R1 would ask for something else then change mind again. Sometimes R1 would ask for a specific type and amount of food and they would provide it for R1. They would place the food on R1’s table and S1 checks to make sure R1 eats it and sometimes would have to co-ax R1 to eat a few bites otherwise, R1 wouldn’t eat the food. Based on FM’s interview, R1’s MD is aware that R1 is not eating much and have discussed with R1 the importance of R1 drinking more fluids. R1 refuses to drink stating that the water tastes like plastic. Resident's underpants are too big Based on staff (S1) interview, R1 likes to stay in bed most of the time and when R1 is lying down, the undergarment should be loose otherwise the moisture around the private area would cause more problems. R1 has been using the same size undergarment since R1 was admitted at the facility. When they tried to use a smaller size undergarment, R1 would tear it up so they switched back to the size R1 was using before. Yard is cluttered with debris On 04/12/21, LPA conducted a video call with S1 via FaceTime to check the facility yard. LPA observed walkers and wheelchairs in the yard. S1 stated that equipment were being used by the residents including R1. LPA observed yard pathway is clear of obstruction. Continued LIC9099-C. The department has completed the investigation of the above allegations. Based on interviews, observations and records review, there is no preponderance of evidence to prove the allegations did or did not occur. Therefore, the Department found the above allegations to be UNSUBSTANTIATED . No deficiencies cited during today's visit. Report was discussed with and a copy provided to Carmen Buno. On 09/13/21, LPA verified with facility staff that the facility has not had any renovations since April 2021. At around 5:30pm, LPA toured the facility backyard with ADM. LPA observed with ADM that one of the ramp railings located on the left side of the backyard is wobbly. The Department has completed the investigation of the above allegation. Based on observations, the preponderance of evidence standard has been met for the above allegations. Therefore, the Department found the above allegations to be SUBSTANTIATED . Deficiencies cited per the California Code of Regulations Title 22, see attached 9099-D. Citation, Plan of Correction and Appeal Rights were discussed, and a copy of reports provided to Carmen Buno.