Complaint·July 19, 2023

Page 2 of 3. Resident denied a refund On 8/6/2021, the Department interviewed Executive Director (ED) via tele-visit. ED stated R1 moved out 2-3 weeks after moving into the facility. R1/R1's Responsibility Party did not give a 30-day notice to the facility and R1/R1's Responsible Party owes partial payment on the rent. ED stated R1 moved into the facility on June 30th 3021 and left the facility July 15th. ED stated R1's Responsible Party signed a contract which states the facility needs to be given a 30 day notice to terminate the agreement and R1's Responsible Party did not provide the notice and facility is still owed 2 weeks of rent. Based on review R1's Admission Agreement signed by R1's Responsible Party on 6/30/2021. The Admission Agreement stated the "term of the Agreement shall be month-to-month, unless and until it is terminated as set forth in this Agreement." Under Community Fee section of the Admission Agreement section (iii) the document states " If this Agreement terminated and you leave PG, for any reason, during the first month of residency, you will be entitled to a refund of eighty percent (80%) of the balance after a five hundred dollar ($500) fee is deducted." Under the Termination - Termination By Resident, the document stated "You may terminate this Agreement at any time, with or without cause, by giving the Executive Director or his/her designee thirty (30) days' prior written notice of termination." R1's Responsible Party signed the document and agreed to abide by the terms. Based on R1's stay at the facility, which was only 15 days, and R1's Responsible Party not providing a 30-day Notice to the facility, R1's Responsible Party does not qualify for a refund. Staff did not ensure resident ate which resulted in weight loss Resident's needs were not met On 8/6/2021, the Department interviewed Executive Director (ED) via tele-visit. ED stated R1 ate in the dining room constantly and staff documented in his/her care notes about his/her food intake. ED stated R1 liked the soup served in the kitchen. ED stated R1's spouse did not want R1 to consume eggs and the kitchen staff make notes to not serve R1 eggs. On previous investigation 8/6/2021 by a former LPA, based on LPA Roadilla's investigation, R1's spouse alleged that staff served eggs to R1 and R1 threw up the eggs. ED stated R1 was not served eggs rather it a mashed cauliflower, and kitchen staff was aware of R1's food/diet. Continuation on LIC 9099-C. Page 3 of 3. Based on review of R1's records, LIC 602A Physician's Report 5/19/2021, R1 has neuro cognitive disorder and was confused and disoriented and his/her weight was at 185lbs. On 6/30/2021, R1 was admitted in the facility wherein his/her weight was taken on 7/1/21 at 178.9lbs. Based on LIC 603A Appraisal, R1 does not have food allergies but does not like to eat eggs. Based on Care Plan dated 06/29/2021, a note was made on the care plan stating "R1 doesn't like to eat eggs". On 7/8/2021, R1's spouse and his/her son/daughter visited R1. During visit R1 was sleeping. R1's spouse assumed that R1 was not provided a meal. Per review of staff notes, R1 refused dinner so staff brought dinner to R1's room. Based on record review and interview, the facility was documenting R1's food consumption. Facility staff made note of days R1 refused food and staff delivered food to R1's room. Based on review of R1's care plan, facility made a note of R1's preference of not eating egg. The Department has investigated the complaint allegation. Based on observation, interview, and record review the Department found the complaint allegations are UNFOUNDED, meaning the allegations are false, could not have happened and/or without a reasonable basis. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Matthew Zahodne, Administrator and a copy of the report was provided.