Complaint·November 10, 2022

table feeding two (2) of the residents. Shortly after LPA's arrival, one of the staff retrieved a tray with empty plate from a resident room. LPA observed most of the food was consumed while residents were at the dining room table and left the table once their plates and bowls were mostly empty. Licensee showed LPA text messages from the facility staff showing the resident meals for the past 3 days and a note with the amount consumed by each resident. Interview with staff and residents revealed that all residents come to the table for meals and eat their meals together at the table, with the exception of one resident who chooses to eat lunch and dinner in their room. Staff provide assistance with feeding 2 of the residents at the dining room table during meal time. Staff interview revealed that sometimes R1 does become tired during mealtime. When R1 becomes tired at the meal, staff indicated it is unsafe to continue to feed R1, due to choking risk, so they will feed R1 an Ensure drink when this happens. Staff interview also revealed that R1 does finish most meals, and they feed R1 first to try to avoid R1 becoming tired during their meal. Based on interview and observation, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation that "staff feed resident less than 3 meals per day" is deemed UNSUBSTANTIATED at this time. The complaint also alleges that staff isolate resident, indicating R1 is left in their room with the door closed. Upon arrival at the facility, LPA observed 5 of 6 residents all seated at the dining table, including R1. After lunch time, LPA observed R1 remained in the common area of the facility for approximately 30 minutes following lunch before being brought to their room to rest. LPA observed other residents in the common areas throughout the visit. LPA also observed doors to resident rooms to remain open during today's visit. Interview revealed that residents are allowed to remain outside their rooms or with their bedroom doors open, unless they are resting or as needed for resident privacy during direct care. Based on interview and observation, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred; therefore the allegation that "staff isolate resident" is deemed UNSUBSTANTIATED at this time. No citations issued for these allegations. Exit interview conducted. A copy of the report was provided via email. Continued from LIC 9099... 11/26/2021. Current Medication Administration Record (MAR) and Centrally Stored Medication record were reviewed for November 2022. Record review revealed that staff were utilizing a medication list from 11/26/2021 to determine which medications R1 is prescribed and to order medications. However, R1 has been under hospice care since 07/21/2022 and the medication list for the period of 09/22/2022-11/20/2022 contains different medications prescribed. Interview revealed that R1 only takes 2 regularly scheduled medications, however the list provided by hospice indicates daily medications Hydroxine hydrochloride, Multivitamin, Trazodone hydrochloride. None of these regularly prescribed medications were present at the facility during today's visit. Additional medications listed as PRN (as needed) Ativan 0.5mg, Betamethasone dipropionate, Lactulose, Levsin 0.125mg, Zophran 4mg were not present at the facility. Interview also revealed that R1's Docusate Sodium was unable to be administered due to waiting on the prescription for delivery. MAR indicated the Docusate Sodium was administered only once on 11/10/2022, however the prescription label is dated 11/07/2022, was divided between two bubble packs and had 3 softgels removed from the bubble packs. Medication review also revealed that R1 has multiple medications ordered as needed (PRN), however, there is no documentation from the physician regarding the parameters by which to administer PRN medications or if R1 is able to determine the need for PRN medication. MAR review revealed R1 has not taken any PRN medications during November 2022, the time period observed. Based on interview and record review, the allegation that "Staff do not dispense medication as prescribed" is deemed SUBSTANTIATED at this time. The complaint also alleges that facility staff do not assist with grooming. Staff interview revealed that R1 receives showers once a week with the hospice shower aide. Staff provide additional showers for R1 if needed. Facility staff shower other residents, however there are two (2) who refuse showers. Shower refusal is not documented, nor is there a process for informing residents' responsible party in the event of a refusal. Regarding additional hygiene needs, interview revealed that toenails are only cut by a podiatrist and due to scheduling conflicts with the current provider, this service has been unable to be provided as of late. Licensee indicated she plans to change to an alternate provider to remedy the situation, but hasn't yet. LPA observed Resident #2 (R2) to have long toenails and R2 stated they cannot cut their own. One resident has a mobile manicurist who visits the resident at the facility, but the other residents do not receive this service. Licensee will inquire as to whether R1's responsible party will allow for this service to be provided. Interview revealed that R1 does wear gloves to limit scratching. Hospice nurse was able to recently assist in trimming Report Continued on LIC 9099-C Continued from LIC 9099-C... R1's nails. Record review revealed that R1 does require assistance with grooming and hygiene needs. Based on interview and observation, the allegation that "staff do not assist resident with grooming" is deemed SUBSTANTIATED at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted with Licensee Aida Cruz. Today’s reports and appeal rights were reviewed and provided via email.