Complaint·February 21, 2024

From 02/02/2024 - 02/21/2024, 9 staff members were interviewed. Based on staff interview, staff are to monitor the resident’s bowel movements daily. Staff document their observation in a bowel movement log which is shredded at the end of every month. If a resident were to not have a bowel movement for 3 days, the caregivers are to report to the Medication Technician. The Medication Technicians then follows their procedures which includes but limited to reporting to the facility’s directors, responsible party, and physician. Based on record review R1 is diagnosed with a neurocognitive impairment and is not able to administered own PRN medication. Facility staff assists resident with the administration of all medications. On 11/22/2023, R1’s home health nurse noticed that R1’s last documented bowel movement was on 11/16/2023 and the facility staff was informed of the observation. The review of records show that R1 has a PRN order for constipation medication with instructions to take 1 tablet daily as needed for constipation. From 11/17/2023 – 11/21/2023, there was no documentation regarding the observation of R1's bowel movements. Based on record review, R1 was only administered the PRN medication for constipation on 11/16/23, 11/22/23, 11/23/23, 11/24/23, and 11/25/23. Records show that R1 was not administered a PRN medication for constipation between 11/19/23 – 11/21/23, which counts 3 days after R1 had a last documented bowel movement. Based on staff interview, staff are instructed by R1’s responsible party to inform the responsible party first, before any PRN medications are administered. Based on record review, there are no notes or documentation that R1’s family member was informed that R1 had not had a bowel movement for over 3 days and the request to administer the PRN medication. Based on record review, the facility was also unable to provide documentation that R1's physician was notified of R1's condition of constipation from 11/19/2023 - 11/21/2023, which counts 3 days after R1 had a last bowel movement. PAGE 2 OF 3. Based on staff interview, 9 out of 9 staff was unaware that R1 had gone over 3 days without having a bowel movement. The Department has investigated the above allegations and the preponderance of evidence standard has been met, therefore, the above allegations are substantiated. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC9099-D. This report was reviewed with Executive Director (ED), Paula Spanek and a copy of the report and appeal rights were provided.