Health inspection·April 18, 2024

Health and Safety Code 1418.91(a)(b) (a) A long-term health care facility shall report all incidents of alleged abuse or suspected abuse of a patient of the facility to the department immediately, or within 24 hours. (b) A failure to comply with the requirements of this section shall be a class “B” violation. Code of Federal Regulations Title 42 483.12 (c)(1) §483.12(c)(1) Ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of patient property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. It was determined based on interview and record review, the facility failed to report an allegation of financial abuse to the California Department of Public Health (CDPH) within 24 hours of the facility’s knowledge of the allegation. This failure to report the allegation of financial abuse to CDPH had the potential to delay the investigation of abuse and further delay the implementation of appropriate action including provision of protection to the patient. In addition, this failure could have subjected Patient 1 to further financial abuse by the alleged abuser. On February 6, 2024, at 8:35 a.m., an unannounced visit was made to the facility to investigate an allegation of financial abuse. On February 6, 2024, at 8:55 a.m., an interview was conducted with Patient 1’s Representative (PR). The PR stated Patient 1 had a private caregiver (CG) who assists Patient 1 with her needs and appointments. The PR stated Patient 1 reported giving the debit card and food stamps card with their pin number to the CG. The PR stated she checked Patient 1’s bank accounts and noticed the spending had gone up significantly. The PR stated she was concerned the CG was stealing money from Patient 1’s bank account. She stated she spoke to Social Worker (SW) 1 and reported her concern regarding Patient 1's CG having access to the patient's bank account. On February 6, 2024, at 9:44 a.m., an interview was conducted with Patient 1. She stated the CG had access to her purse, which had her bank cards and food stamp cards in it, and she stated the CG had full access to all those cards. On February 6, 2024, Patient 1's record was reviewed. Patient 1’s admission records indicated she was admitted to the facility on January 12, 2024, with diagnoses which included acute respiratory failure (lung failure), history of lung cancer, and history of stroke. A review of the "Minimum Data Set (MDS - an assessment tool)," dated January 19, 2024, indicated Patient 1 had a Brief Interview of Mental Status (BIMS - an interview to assess mental intactness) score of 15 (cognitively intact). On February 6, 2024, at 10:45 a.m., an interview was conducted with SW 1. SW 1 stated the PR had voiced concerns during the initial assessment regarding the CG having access to Patient 1’s finances and there was some bank activity (drawing money out with ATM card), while the patient was in the hospital. She stated the PR had initiated a call to Adult Protective Services (APS), and APS had been in contact with both Patient 1 and the PR. SW 1 stated APS was conducting the investigation. SW 1 further stated she did not report the PR's concerns of financial abuse by the CG on Patient 1 to the Administrator (Admin) or the Director of Nursing (DON). SW 1 stated it is the facility’s policy to report suspected abuse immediately to the abuse coordinator. On February 6, 2024, at 11:29 a.m., an interview was conducted with SW 2. SW 2 stated the PR mentioned to her that there were "suspicious" charges on Patient 1’s bank account. SW 2 stated she gave the PR the number to APS to report suspicion of financial abuse. SW 2 further stated "I should have called APS to report the allegation of financial abuse." SW 2 stated the facility's protocol was to report suspected abuse immediately to supervisors. On February 6, 2024, at 3:24 p.m., an interview was conducted with the Director of Nursing (DON). She stated the facility's policy was to report suspicions of abuse immediately to the abuse coordinator, the Admin. The DON further stated SWs 1 and 2 did not report the PR's allegation of financial abuse by the CG towards Patient 1 to the Administrator. On February 6, 2024, at 3:29 p.m., an interview was conducted with the Admin. He disclosed not receiving a report from SWs 1 and 2 on the PR's allegation of financial abuse by the CG towards Patient 1. The Admin stated the SWs should have reported the incident or alleged financial abuse to APS and to him so he could have thoroughly investigated the allegation. He stated the allegation of financial abuse should have been reported to CDPH within the required timeframe. A review of the facility's policy and procedure titled "Abuse, Neglect, Exploitation or Misappropriation - Reporting and Investigating," revised April 2021, indicated, "...All reports of (patient) abuse (including injuries of unknown origin), neglect, exploitations, or theft/misappropriation of (patient) property are reported to local, state, and federal agencies (as required by current regulations) and thoroughly investigated by facility management. Finding of all investigations are documented and reported ...Reporting Allegations to the Administrator and Authorities ...If (patient) abuse, neglect, exploitation, misappropriation of (patient) property or injury of unknown source is suspected, the suspicion must be reported immediately to the administrator and to other officials according to state law ..."Immediately" is defined as: a. within two hours of an allegation involving abuse ..." It was determined based on interview and record review; the facility failed to report an allegation of financial abuse to CDPH within 24 hours of the facility’s knowledge of the allegation. This failure to report the allegation of financial abuse to CDPH had the potential to delay the investigation of abuse and further delay the implementation of appropriate action including provision of protection to the patient. In addition, this failure could have subjected Patient 1 to further financial abuse by the alleged abuser. This violation had a direct or immediate relationship to the health, safety, security of the patients.