Follow-up·November 20, 2023

Licensing Program Analyst Manuel Monter & Mita Partoza conducted an unannounced case management to amend a complaint investigation LIC9099 and LIC9099-D issued on November 16, 2023.(26-AS-20230308155736) LPAs met with (LN) Licensee Irish Ladwig explained the purpose of the visit. On March 15 & November 16, 2023, LPAs interviewed ADM, S1 and Licensee (LN). ADM, LN and S1 stated R1’s shared bathroom was locked due to R1’s fecal smearing behavior. Staff also stated, although R1’s shared bathroom was locked, he/she still had access to the other two bathrooms with supervision. ADM also stated that they found R1's clothes in shower and staff feared fall risk at night. ADM stated R1 would hide used toilet paper around his/her bedroom. ADM stated they have found R1's diaper hidden under his/her roommate’s bed. The licensee stated R1's bathroom is locked, due to R1’s behaviors. Based on a review of R1’s physician’s Report January 4, 2023, R1 has a neurocognitive disorder. R1 is incontinent on both bowel and bladder. Furthermore, under ‘mental condition,’ R1 has fecal smearing behavior and wandering behavior. R1 requires assistance with ADLs such as, but not limited to bathing and toileting. Based on a review of R1’s Appraisal/Needs and Services plan, LIC625 dated December 23, 2022, R1 has a rummaging behavior evidenced by digging though cabinet drawers, bathroom and taking items from one place and hiding them all over the house. R1 also had a behavior of by digging out his/her bowel movement through his/her undergarment. In addition, ADM also noted on LIC625 that R1 requires a toilet scheduling every 2-3 hours and R1 needs to be supervised when he/she enters the bathroom on his/her own at all times. Page 1 out of 3. ADM and staff stated R1 has been found smearing early hours of the morning. ADM stated the facility does not have an awake night staff. A review of the facility’s LIC500 dated September 25, 2023, shows there is no wake night staff. Further review of R1’s LIC625, the ADM’s objective plan under the following areas “Mental, Physical/Health, functioning skills” does not address R1’s behaviors. ADM wrote under “evaluating progress,” the facility staff is to put R1 in a toileting schedule and supervise R1 when he/she is going to the bathroom on his/her own. According to Title 22 code of regulations, 87625 Managed incontinence (a) The licensee shall be permitted to accept or retain a resident who has a manageable bowel and/or bladder incontinence condition under the following circumstances…(B) a structured bowel and/or bladder retraining program to assist the resident in restoring a normal pattern of continence. (C) a program of scheduled toileting at regular intervals. A review of R1’s file does reveal the facility did not have documentation on R1’s toileting. ADM stated that they do not have a log on toileting and notes regarding R1 behavioral episodes. In addition, a review of R1’s LIC625, locking of R1’s shared bathroom (located in bedroom #1, based on the floor plan) is not written on the agreed upon plan, dated December 23, 2022. Based on interview staff S1 and ADM, staff interviewed were unable to provide of how they are adhering to the plan in place. Staff were not aware of the toileting plan and always supervise R1 when he/she goes to the bathroom on his/her own. Based on interview with ADM, there is no awake night staff and there is no toileting log. ADM and licensee stated R1’s shared bathroom was locked as a solution to prevent resident from smearing feces which also violates R1 and R5’s personal rights under code section 87468.1(a)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. R1 shared a bedroom with R5. Staff stated that R5 gave permission to lock bathroom. R1 has neurocognitive disorder. Page 2 out of 3. ADM stated, “…sometimes when we are busy, that's when he/she’s doing it, the smearing.” ADM stated that R1 behaviors occurs during sleeping hours. Staff stated that they would at times hear movements from R1’s bedroom, and also during waking hours at 6:30AM wherein R1 was found with feces in bed, clothing and bedroom walls. ADM stated the smearing behavior always happened when he/she was alone. Deficiencies are being cited. See LIC 9099-D. Exit interview conducted with Licensee Irish Ladwig and a signed copy of this report was provided along with appeal rights. On 11/20/2023, at approximately 4:45pm. The report was presented to the Licensee and Licensee refused to sign. A copy of the report was printed and was handed to ADM. Appeal rights were printed and handed to ADM. Page 3 out of 3.