complaint·March 7, 2023

On 03/01/2023, LPA Ascencio reviewed R1’s medical records which confirmed R1’s diagnosis and admission to hospice. Additionally, various narrative charting notes revealed that on 01/09/2022, “Resident spit out ensure this AM. Cleaned resident mouth and lips.”, and on 01/10/2022, “ Nurse from Los Robles Hospice came for a visit. Nurse stated residents’ mouth was very dry and had chocolate ensure. Resident has been combative not allowing mouth care. Nurse will call family member and ask for mineral oil for dryness.” Later that same day, review of hospice documentation revealed that on 01/05/2022 oral care was discussed with Pacifica staff. On 01/10/2022, “Pt mouth was dry & crackling. PT won’t allow for mouth care, tries to push away” and oral mineral oil was recommended. On 01/12/2022, oral care was provided by hospice nurse. On 01/14/2022, R1’s hospice physician wrote an order to provide oral care 3x a day. R1 passed away on 01/18/2022. Prior to 01/05/2022, there was no written documentation regarding the need for oral care in either Pacifica Senior Living documentation or Hospice Documentation. Although staff documentation stated they attempted to do their due diligence in conducting oral hygiene for R1 after 01/05/2022, documentation from hospice agency confirmed the attempts and behavior episodes of R1. LPA Ascencio attempted various times to conduct interview with Hospice Agency worker but was unsuccessful. Interview with two (2) staff members on 03/7/2023, starting at 11:09 a.m., confirmed R1’s aggressive behaviors towards staff and other residents. Additionally, staff members added that R1 would not allow staff to help R1 with any activities of daily living, thus R1’s health would rapidly decline. Although facility and hospice documentation stated staff attempted and provided minimal oral care for R1, there was no documentation regarding an infection or disease in R1’s mouth. Additionally, the Department received the complaint on 01/13/2022, alleging of resident's oral hygiene needs were not met, but on 01/14/2022, hospice physician wrote an order to provide oral care. Staff interviews could not validated whether oral care was provided after the written order of 01/14/2022, but the ongoing struggle of R1’s aggressive behavior to provide oral care or any ADLs was documented both by Pacifica and Hospice. Based on the information obtained, there is insufficient evidence to support the claim that the resident’s oral hygiene was not met. Thus, the allegation above is deemed Unsubstantiated at this time. Continued on LIC 9099 - C Regarding the allegation of resident did not receive medical care in a timely manner. R1 was admitted to hospice care on 10/11/2021 with a terminal diagnosis of Alzheimer’s Disease. According to hospice documentation reviewed on 03/01/2023, it was revealed that R1 was being visited by hospice agency representatives 3-5 times each week for the months of November and December 2021. Because R1 was on hospice, R1 was seen frequently by a nurse, health aide, medical social worker and chaplain. Review of Pacifica’s documentation on 03/01/2023, revealed that due to R1’s advance stage of Alzheimer’s Disease, there were very frequent falls and aggressive behaviors towards staff and other residents. Documentation also revealed staff communicating with R1’s family member and hospice agency when any behaviors and fall occurred. Hospice documentation revealed that on 01/05/2022 oral care was discussed with Pacifica staff, yet hospice representatives also knew and documented about R1’s behaviors and the refusal of care. Additionally, hospice intake documentation state “Do not call 911. Call us first.” Per a review of notes and staff interviews, there was no indication that R1 required immediate medical care outside of the conversation with the hospice nurse regarding R1’s oral care on 01/05/2022. Prior to the 01/05/2022 conversation, facility notes nor hospice notes prior to this date indicated any concerns regarding R1. As previously stated, parties were aware of R1’s refusal of care and behavioral challenges. After the conversation with the hospice nurse, staff documented efforts in tending to R1’s hygiene and oral needs. Although the complaint alleging resident did not received medical care in a timely manner was submitted to the Department on 01/13/2022, R1 was being seen by the hospice agency since date of admission on 10/11/2021 until death in 01/18/2022. Based on the information obtained in interviews and record review, there is insufficient evidence to support the claim that the resident did not receive medical care in a timely manner. Thus, the allegation above is unsubstantiated at this time. Exit interview conducted and a copy of the report was issued to BOM.