Complaint·January 6, 2025

As of 12/30/24, R1’s family could not be contacted as the phone number was no longer in service, as such R1 could not be contacted. Administrator at the time of the incident is no longer employed at the facility and current administrator has no knowledge of the incident that occurred on 6/16/23. LPA Miller reviewed 6/12/23 LIC 602, that stated R1 had end stage dementia and no capacity for self-care. R1 is non-ambulatory based on both physical and mental condition. LPA reviewed R1’s Needs and Services Plan that indicated R1 required one person assistance with oral, skin and daily grooming and requires a reminder assistance with dressing and undressing. Based on the information available, there was no indication R1 required additional supervision that was not provided and that led to the injury. Administrator, Jill Morris Chapman stated that that on 6/15/23, there were 14 Memory Care residents and 68 independent and assisted living residents. Based on the records, on 6/15/23 there was 1 staff working NOC shift in Memory Care and on 6/16/23 there were 2 staff working AM shift Memory Care. Administrator stated that facility currently has 12 residents in memory care and 1 NOC staff is sufficient, as clients are settled down between the hours of 10:00 p.m. and 6:00 a.m. Although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time. An Exit interview conducted and a copy of this report an appeal rights were issued. LPA reviewed 6/16/23, Incident Report, that indicates R1 was observed on floor at 8:30 a.m. The document states, “Hospice Notified” and R1 taken to Ventura County Medical Center. It is unclear who prepared the report. It is relevant to note that there is no record that this document was submitted to Community Care Licensing. It appears that Mission Hospice was notified. There is no evidence to support that family member was notified as required by regulations. Based on LPAs record review, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, are being cited on the attached LIC 9099D. An Exit interview conducted and a copy of this report an appeal rights were issued.