complaint·July 7, 2023

Allegation: Facility failed to seek timely medical attention for resident in care: It was alleged that Resident #1 (R1) fell while at the facility, resulting in a fractured femur and the facility did not send R1 to the hospital due to R1 receiving hospice services. Record review revealed that R1 fell on the following dates: 07/01/2021 resulting in a small abrasion to R1’s cheek, 07/03/2021 with no visible injuries noted, and 07/04/2021, which resulted in a bump to R1’s forehead, R1 “moaning with facial grimacing to touch and pressure to right leg.” According to the incident report and internal incident report, the fall occurred at 09:40PM. Hospice nurse notes dated 07/04/2021 indicate “called daughter and left voicemail. Gave option to bring to hospital or to keep [R1] comfortable at this time. Per [facility med tech,] [R1’s] daughter currently on vacation.” Internal incident report dated 07/05/2021 at 12:00AM indicates hospice “requested that [R1] not be sent to hospital because [R1] is admitted on hospice. A nurse will visit to reassess [R1] during daytime.” Additional internal incident report dated 07/05/2021 at 11:50AM indicates when staff arrived at the facility for the morning shift and was making morning rounds, R1’s “right hip was warm to touch and [R1] was screaming in pain.” Incident report further states facility staff called hospice, who indicated “working on trying to send a tech to get an x-ray done.” At 11:45AM, facility received a call from hospice giving authorization to call 9-1-1 and send R1 to the hospital. Progress notes dated 07/06/2021 indicate R1 sustained a right femoral fracture due to the fall that occurred on 07/04/2021. Although R1 is on hospice, the fall, which resulted in a bump on R1’s forehead and femoral fracture are not related to the expected course of R1’s terminal illness. As thus, regulations related to hospice care and informing hospice rather than calling 9-1-1 do not apply to the incident involving R1. Documentation provided reflects that R1 fell on or around 09:40PM on 07/04/2021 and although staff indicated R1 was “screaming in pain,” 9-1-1 was not called until 11:50AM on 07/05/2021. Therefore, based on interview and record review, the allegation that “facility failed to seek timely medical attention for resident in care” is deemed SUBSTANTIATED at this time. Allegation: Licensee did not allow resident(s) to select their own health care provider: The complaint alleges that the Licensee is forcing staff to refer residents to Aasta hospice and home health and forcing families to switch providers. During the course of the investigation, LPA spoke with family members of facility residents directly, as well as reviewed the list of providers, facility Admission Agreement, and a letter that was sent to residents’ families by the Administrator. According to the letter sent from the Administrator, Aasta’s hospice and home health preferred companies are as follows: Aasta Home Health Report Continued on LIC 9099-C and Hospice, Free Spirit Hospice, and Faithful Hospice, all of which appear to be companies owned by the Licensee. The letter further states that “services provided through our partners are included in our monthly pricing. Residents who choose a hospice and/or home health provider other than one of our preferred partners will be charged $500 per service per month for the duration of services.” Families interviewed indicated that they were approached by facility staff and asked to change providers or to enroll in hospice services with one of their providers if the resident was not already receiving hospice services. Although the letter indicates residents can choose an alternate provider, an additional charge will be added to their services for choosing an alternate provider, which is not indicated in the Department-approved Admission Agreement. Families interviewed indicated the additional cost was a factor in choosing their health care provider. Based on interview and record review, there is a preponderance of evidence to support the allegation, therefore, the allegation “Licensee did not allow resident(s) to select their own health care provider” is deemed SUBSTANTIATED at this time. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 9099-D). Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of today's reports and appeal rights were provided. Allegation: Illegal Eviction: It was alleged that after Resident #1 (R1) sustained a fall at the facility, which resulted in a fractured femur, the Licensee did not readmit R1 to the facility. Interview revealed that R1 did not return to the facility, however the facility did not evict R1. R1 had an unpaid balance for services rendered at the facility and prior to the facility issuing an eviction notice, the fall occurred, and R1 did not return. LPA attempted to call R1’s family member to confirm information provided by the facility, however, LPA did not receive a call back. LPA reviewed records sent to CCL during the time of the complaint and an eviction notice for R1 was not sent to CCL for approval. Interviews with staff confirmed R1 did not return following their hospitalization and the family retrieved R1’s personal belongings some time after the incident. Based on interview and record review, 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 “illegal eviction” is deemed UNSUBSTANTIATED at this time. Allegation: Staff are not sufficient in numbers and competent to provide services necessary to meet resident needs: The complaint alleges at the time of the complaint, the facility is short staffed, with only 1 or 2 caregivers on the floor. Interviews revealed that the facility was utilizing staffing agency to supplement facility staffing. According to interviews, at all times, there is a minimum of 2 caregivers present in each side of the facility – Meadows and Assisted Living. Staff interviewed indicate there have been times of lower staffing, which makes it difficult to manage, but the medication technician will step in and help as well as during the day there is management staff and additional extra staff that come assist the residents as needed. Residents interviewed indicate that at times they do have to wait for assistance, but that the care provided is sufficient and their needs are being met. 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 “staff are not sufficient in numbers and competent to provide services necessary to meet resident needs” is deemed UNSUBSTANTIATED at this time. No citations issued related to the above allegations. Exit interview conducted. A copy of today's reports were provided.