Complaint·December 13, 2022

intermittently throughout the investigation and LPA reviewed pertinent documents. The following was then determined: Regarding the allegation “Inadequate staffing to meet the needs of the residents:” During the time period the complaint was received, the facility was experiencing a significant COVID outbreak, which was initially reported on 12/28/2020 and resulted in continued daily communication and support from CCLD through 02/02/2021. During the time period of the complaint allegation, locating qualified staffing was challenging for not only the facility, but the caregiving industry as a whole. Interview revealed that the facility had many regular staff who had tested positive for COVID and were therefore not cleared by Public Health to work. The facility had signed contracts with two different staffing agencies and were able to schedule staff to work with the COVID positive cohort. However, many agencies just did not have available staff. Interview with Administrator revealed Martha had called “so many staffing agencies and no one has staff available.” Care logs reviewed revealed the facility employed 788.25 hours of agency care staff for the time period of 12/07/2020 – 01/31/2021. Administrator contacted CCLD for additional staffing resources and still struggled to obtain adequate replacement staffing. Administrator tried alternate strategies such as scheduling staff for 12-hour shifts rather than the regular 8-hour shifts and had employed an “all hands on deck” strategy where even salaried management staff stepped in to complete daily caregiving tasks and serving residents’ meals. Administrator had spoken with Ventura County Public Health about alternate staffing resources and worked within their company’s corporate entity to create alternate staffing solutions. Interview with staff and residents revealed that residents’ needs were met. Residents reported that they did have to wait at times, particularly for meals, but that the staff that were there remained helpful and positive throughout the pandemic. Interview revealed that as COVID positive staff were cleared to work, they were brought back into the facility and staffing concerns subsided. Based on interview, 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 “inadequate staffing to meet the needs of the residents” is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Facility is not safeguarding residents’ belongings:” The complaint alleges that during the time of the COVID outbreak, that residents were moved to alternate rooms and some of their personal belongings were not brought with the residents. At the time of the Report Continued on LIC 9099-C complaint allegation, the facility was experiencing a significant COVID-19 outbreak. At the direction of Ventura County Public Health, the facility management staff made the decision to create a cohort of COVID positive residents to limit COVID exposure to the remaining residents and staff. The facility set up a cohort on the second floor of the facility, so staff caring for COVID positive residents could enter and exit the building separate from staff caring for residents who had tested negative for COVID and had no known COVID exposure. Interviews revealed that Assisted Living residents were instructed to pack up their personal belongings in anticipation of their temporary relocation. Interview revealed that the facility maintenance staff as well as hired movers were brought in to assist in moving the residents’ beds, chairs, necessary items, and all packed personal belongings to their new rooms. Interview also revealed that residents’ family members were allowed on premises to assist their loved ones in moving personal belongings to their temporary cohort location. The facility was instructed by Public Health officials to create cohorts in the interest of safety for all the residents. Interview revealed that no items were reported missing during the transition into the cohorts and back into their regular apartments. Based on interview, 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 “facility is not safeguarding residents’ belongings” is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Residents’ authorized representatives are not notified of changes in residents’ conditions:” It was alleged that facility staff did not notify families of their loved ones’ COVID status in a timely manner. Throughout the course of the investigation, LPA Dulek spoke with residents’ family members regarding the facility communication. Interviews revealed that there were a few days of transition between Administrators where communication wasn’t ideal. However, shortly thereafter, the families began receiving messages and recordings from the facility as well as email communication. There had been a power outage at the facility while the facility staff were working on relocating residents to their COVID-positive and COVID-negative cohort locations, but that was resolved within the day during normal business hours. The facility organized a family Zoom meeting, as in-person meetings were limited by Ventura County Public Health due to the COVID outbreak. Staff interviews revealed that caregiving staff continued utilizing their communication logs regarding the residents’ care status throughout the pandemic. While Administrative interview revealed that communication could have been better, due to the size of the outbreak at the facility and the large number of residents and staff affected, they had to utilize creative communication methods to Report Continued on LIC 9099-C accommodate the facility’s needs within the constraints of the COVID lockdown. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation, therefore, the allegation “residents’ authorized representatives are not notified of changes in residents’ conditions” is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Residents are not being offered activities:” At the time of the complaint, the facility was in contact with Ventura County Public Health and had been given guidance in order to mitigate the spread of COVID-19 within the facility. Many staff and residents had tested positive for COVID, so some staff were unable to work and residents were directed to remain in their own individual apartments, for their health and safety. Visitation was limited to essential visitors only, by direction of state public health guidelines, therefore outside vendors were not permitted inside the facility at that time. All communal dining and congregate activities were restricted at the direction of public health in order to limit transmission of COVID-19. Interview revealed that activity staff were reallocated to alternate jobs to help with the facility’s staffing shortage. During the time the complaint allegation was made, the facility was focused on COVID mitigation and ensuring the safety of all residents. The complaint alleges that residents were moved to alternate rooms to cohort and left without entertainment or amenities the facility regularly offers. Interviews revealed that the facility currently provides basic cable in all apartments and that residents were instructed to gather their personal belongings they wished to move to the temporary rooms. Interview further revealed that residents’ families were permitted to assist in temporarily relocating their loved one and moving anything the resident desired to their temporary location. Staff interview did reveal that at that time there were no activities staff, but that residents had the ability to request individual in-room puzzles or newspapers. Therefore, based on interview, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred; as thus, the allegation “residents are not being offered activities” is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Appropriate variety of foods not provided to residents:” During the complaint inspection, LPA Dulek reviewed the facility menu provided to residents. At the time of the allegation, the facility was experiencing a COVID outbreak, and therefore had closed all common areas, including the dining room. Residents were asked to order their meals in advance using the menu paper provided. Interview revealed that residents were asked to choose as many or as few choices as they preferred for each meal. For breakfast, residents had a choice of 5 entrée options, 5 sides, and 6 drink Report Continued on LIC 9099-C options, as well as condiment choices. For lunch, residents had a choice of 5 entrées, 5 sides, and 5 drink choices, as well as a fill-in-the-blank line for dessert. For dinner, residents had 8 entrée options, 7 side dish choices, and 5 drink choices, as well as a fill-in-the-blank line for dessert. The weekly menu was also provided to residents and listed the daily specials. Foods listed on both the weekly menu and the ordering menu provided options from all food groups and contained varied choices within each food group. Additionally, during the course of the investigation, LPA interviewed residents. Residents indicated the facility food is sufficient and varied. Therefore, based on record review and interview, although the allegation may be valid, at this time, there is insufficient evidence to support the allegation or that a violation occurred; as thus, the allegation “Appropriate variety of foods not provided to residents is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Staff did not ensure resident received meal:” During the investigation, LPA Dulek interviewed multiple residents and staff. At the time of the complaint allegation, the facility was experiencing a COVID outbreak within the facility. At Public Health’s direction, to ensure the health and safety of all residents, the residents were asked to remain in their own individual rooms. Meals were then cooked in the facility kitchen, delivered in carts to each floor of the facility, then delivered to individual rooms by care staff during their care rounds. Staff interviews revealed that the process of food delivery was very lengthy in time and food would cool before the staff could make all their deliveries. As such, care staff would heat the food for the resident in their apartment when delivering food. Some residents preferred staff to leave the meal on their table in their apartment, some wished to eat right away and some were resting when food was delivered. Resident interviews revealed that lunch was delivered late, around 1:00-1:30PM by the time they got to the 3 rd floor. One resident stated they had not been delivered food at all one weekend and another resident indicated they “went without a lot of meals.” It is unclear whether the residents were served food and did not eat it or whether the residents were aware food was delivered to them. Staff interview revealed that they would leave the food on the resident’s table then were instructed to go back later and discard any uneaten food. Staff interviewed stated on several occasions it was difficult to tell if the plate had been touched or not, if the resident chose not to eat, or the resident did not know the food had been delivered. Staff indicated they did deliver food to all their assigned residents daily and did not hear feedback that food was not delivered in other areas. As thus, based on interview, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a Report Continued on LIC 9099-C violation occurred, therefore the allegation that “staff did not ensure resident received meal” is deemed UNSUBSTANTIATED at this time. No citations related to this complaint were issued. Exit interview conducted. A copy of the report was provided via email.