complaint·May 12, 2025

Continued from LIC9099-C... Based on interviews conducted with Licensee, RV is used as personal for leisure activities. Interviews with staff (S1 and S2) indicates that they are live-in staff who resides in caregiver’s room #8 as indicated in their fire clearance. Based on records review, the facility provided LPA with LIC500 Personnel report dated 3/6/2025 revealed that S1 was listed in the facility schedule. However, during file review, it was revealed that S1 was cleared, but they were not associated to the facility, LPA informed Licensee that S1 should never be working and providing care to residents prior to a criminal record clearance or exemption. The Licensee immediately discovered that there was a discrepancy in the name of S1, so they submitted appropriate correction request to properly associate S1 to the facility roster through Guardian system. On 3/30/2025, the Licensee submitted updated Guardian Roster confirming that after corrections made, S1 was associated to the facility as of 3/6/25. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is cited on the attached LIC 9099D. Appeal Rights Given. Civil penalties are being assessed in the amount of $100 for allowing a person to work, reside or volunteer in the facility without a been associated to the facility. Continued from LIC9099... During tour of the facility, LPA observed a signed on R2’s room door stating the following: “Contact Isolation - standard precautions prior to entering the room: clean hands, gown and gloves – visitors see nurse before entering”. Based on records review, the facility submitted incident report dated 3/30/25 confirming to the Department, R2’s diagnosis along with staff training records dated 3/28/25. Regarding hospice resident who passed away possible due to negligence of staff. Licensee provided LPA with death report of resident (R1) who was receiving hospice services when they passed away on 12/3/24 along with death certificate #5409158 obtained from California Death Registration System indicating that R1’s immediate cause of death was senile degeneration of brain without any other significant condition that could contributed to their death. A finding that the complaint allegation occurs of personal rights is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.