On today’s visit, LPA Yee reviewed resident files and collected copies of facility files at 2:04pm, interviewed David Aguiniga, Executive Director at 11:10am, Assistant Administrator at 11:57am and Staff #5 at 4:17pm,

Per information gathered from the interviews conducted regarding Allegation #1 – staff are verbally abusing residents, some of the residents that were interviewed stated that they are not verbally abused by staff. Staff are cold, have attitudes and some just ignore the residents. Some residents indicated the staff are nice and respectful. Resident #1, who is specifically named in the complaint as being one of the residents who was verbally abused by staff, was interviewed and they stated that they don’t remember being verbally abused. Per staff interviewed, including Staff #1, they all deny verbally abusing the residents in care. They state that it is the residents that verbally abuse them. Resident #1, Resident #7 and Resident #8 curse out the staff However, per interviews conducted with Staff #2 on 10/5/23, they walked in on Staff #4 having a heated conversation with Resident #1 during medication time. This happened about 2 weeks ago, around 8:30pm or 8:45pm. They were short staffed since one of the Medication Tech was out on disability. Resident #1 was asking for their medication and told Staff #4 "I wanted my f...medications" and Staff #4 responded to Resident #1 "I'm trying to give medications, f....you too." Resident #1 walked away. Per information obtained from Staff interviewed, Staff #4 is regularly called into the office and is talked to about their treatment of the residents. One of the office meetings involved Staff #4 cursing out a resident but the resident was not identified as the meetings are confidential. Based on the information received, there is sufficient evidence to support the allegation that staff are verbally abusing residents. Therefore the allegation is SUBSTANTIATED at this time.

Per interviews conducted with staff and residents regarding Allegation #2-Staff are not providing residents with medication in a timely manner- staff deny that medications are not dispensed in a timely manner. Per Staff #1, if medications are late, it is only for a few minutes but no more than 10 minutes. Per the information provided on the complaint, the medications are dispensed late on the 2:30pm-11pm shift. Per interviews conducted with residents at the time the complaint was received, they get their medications sometimes before lunch, during lunch, at 9pm or at 10:30pm. When the complaint was received the facility was short staffed and short a Medication Technician due to going on disability leave. Medication Technician that was working on the second shift was also observed on personal calls on their cell phone and ignoring the residents who were requesting their medications. Since the complaint was received, 2 Medication Technicians have been terminated and one quit. Based on the information received from the investigation, there is sufficient evidence to support the allegation that the staff are not providing residents with medication in a timely manner, therefore the allegation is SUBSTANTIATED at this time.

Per the Investigation regarding Allegation #3 - Staff are not ensuring residents files are up to date - the Reporting party states the resident facility files do not have Physician Reports and the results of TB tests. Per review of files for Resident #2, Resident #3, Resident #4 and Resident #6, their files contained the required Physician's Reports with the results of the TB test, Based on the file review, there is insufficient evidence to support the allegation that the staff are not ensuring residents files are up to date, therefore the allegation is UNSUBSTANTIATED at this time.

Exit interview was conducted and a copy of this report was provided.