Complaint·January 7, 2025

R1’s Medication Administration Record (MAR) indicates staff checked R1’s skin from 07/13/2023 to 07/17/2023 and found no issues. The next skin monitoring in R1’s MAR is recorded on 08/29/2023 to 08/31/2023. The AM entry for 08/29/2023 states that R1 has no skin issues. The PM entry for 08/29/2023 states that R1 does have skin issues. The entries for 08/30/2023 and 08/31/2023 state that R1 has skin issues. The entry in R1’s MAR for 09/01/2023 states R1 has skin issues. The 24-Hour Communication Logs from July 2023 state the following: R1 was observed to be confused on 07/13/2023, 07/16/2023, 07/18/2023, 07/26/2023, and 07/27/2023. On 07/27/2023, the 24-Hour Communication Log states R1 refused to shower and R1’s rectal area was observed to be red and painful. The 24-Hour Communication Log from 07/31/2023 states R1 was observed to be hoarding dirty underwear and didn't want to wash them or change clothes because R1 believed that R1 would be leaving the facility soon. The ADL (Activities of Daily Living) Resident Refusal Form from 07/13/2023 states that R1 refused an ADL on that day; however, the form does not specify the specific ADL that R1 refused. The form states that staff provided three interventions and R1 refused all the interventions. The form states that undergarment/brief change, peri care, clothing change, and face/ear wash were completed as alternate hygiene care for R1. The 24-Hour Communication Logs from August 2023 indicate staff provided R1 with a shower on the following dates: 08/02/2023 (time not indicated), 08/09/2023 PM, 08/16/2023 PM (R1 refused), 08/17/2023 PM, 08/20/2023 AM (R1 refused), 08/20/2023 PM, 08/23/2023 AM, and 08/27/2023 AM. R1’s Chart Note from 08/16/2023 9:38 PM states that R1 refused three staff prompts for a shower. On 01/07/2024, LPA Marrufo interviewed staff S2-S5. S2-S4 stated that staff would provide showers to R1 twice a week. S5 stated that R1 would often refuse staff’s encouragement to take showers. Page 2 of 4. LPA Marrufo received an email from R1’s Responsible Person on 08/31/2023 7:26 PM. R1’s Responsible Person stated in the email that staff could not provide the ointment that R1’s Responsible Person provided to R1 since the ointment was not prescribed. R1’s Responsible Person states staff told R1’s Responsible Person that they provided a barrier cream instead and R1’s rash was now gone. R1’s Physician’s Orders states that on 08/23/2023, R1 was prescribed an ointment as a PRN for a rash diagnosis. R1’s Medication Administration Record (MAR) indicates staff checked R1’s skin from 07/13/2023 to 07/17/2023 and found no issues. R1’s MAR indicates there was no entry into the Skin Issues log but staff nonetheless applied R1’s prescribed ointment for skin rashes on the following dates: 08/23/2023, 08/24/2023, 08/25/2023, and 08/27/2023. R1’s MAR indicates staff recorded skin issues with R1 and applied R1’s prescribed ointment for skin rashes on the following dates: 08/292023, 08/30/2023, 08/31/2023, and 09/01/2023. LPA Marrufo did not observe any other dates in R1’s MAR that indicated R1 was observed to have had skin issues. On 09/01/2023, LPA Marrufo conducted a medication review of residents R1-R3 with staff S1. During medication review, LPA Marrufo observed 5 medications belonging to R1. 3 out of 5 of R1’s reviewed medications did not contain a start date on the medication container. LPA reviewed 4 of R2’s medications, and all 4 medications had a start date. LPA reviewed 7 of R3’s medications. 2 out of 7 reviewed medications belonging to R3 did not have a start date on the medication container. S1 stated that typically medications have stickers with start dates on the medication container. S1 stated to not be able to say why some of the medications were missing start dates. During interview on 01/07/2025, S6 stated that when a resident is newly admitted to the facility and the resident's family brings medications with the resident, the medications often do not have start dates on them because there is no way to verify the actual start dates of the medications. S6 stated to be certain that this was the case with R1's medications and possibly other resident medications. S6 stated that medications of new residents are counted when they first arrive. Page 3 of 4. On 01/07/2024, LPA Marrufo interviewed staff S2-S5. S2-S5 stated to have never observed a time when R1’s prescribed rash ointment was not given as prescribed. S2 stated to have never observed a time when R1 was not given medications as prescribed. S3-S5 stated to not have any information as to whether or not R1 was ever not given medications as prescribed. An Advisory Note has been issued. See LIC9102 for more information. Based on information from interviews conducted with staff, and records reviewed, although the allegations listed above 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 allegations are unsubstantiated. No Deficiencies were cited under California Code of Regulations Title 22 This report was reviewed with Administrator Steven Silacci and a copy of this report was provided. Page 4 of 4. END REPORT