On 10.9.2024 at 9:25 AM, LPA requested the resident and staff roster. At 9:45 AM, LPA requested copies of pertinent information which include, but are not limited to Physician’s report, Admission Agreement, Staff Training, LIC 500 (Personnel Report), LIC 9020 (Resident Roster), hospice records, needs and service plan, and relevant documents to the investigation. Between 10 AM-10:30 AM, LPA interviewed the Administrator and two (2) out of two (2) staff and four (4) out of six (6) residents, who are in the facility.

LPA visited Resident #1 (R1) at US Renal Care in Van Nuys on 10.9.2024 at 12:25 PM. LPA observed that R1 had multiple bruising on bilateral forearms, bruising on right-hand phalanges, and skin tears on the right (R) bicep measure 0.5 x 1 inch. R1 right eye tear duct was also full of morning glories. Interviews with the residents revealed that the facility staff does not reposition appropriately.

When assisting and/ or repositioning staff would either push the resident against the wall while in bed and or against the bed-rail which causes R1 bruising. LPA interviewed R1 and reviewed the Centrally Stored Medication Destruction Record (CSMDR) to determine whether medications could have caused the bruising. Upon review R1 is not taking any blood thinners or other medications that would cause the bruising. This was also confirmed by the resident. LPA reviewed staff records for training regarding care. The staff has undergone forty (40) hours of training upon on-boarding to the facility before caring for residents. While staff had documented training it appears that staff lacked knowledge in appropriately repositioning a resident to prevent bruising. Staff could have used a bed sheet to shift the resident or other approach to avoid harming and bruising the resident. The facility failed to take alternate appropriate measures to ensure that there was no immediate threat to the health and safety of the residents. Overall, the investigation revealed that the facility Administrator was aware of R1's care.

Based on the information revealed from interviews and records review, there is sufficient information to support the above stated allegation. Therefore, the allegation is determined to be substantiated at this time.

Allegation #2: Staff do not ensure that resident's hygiene needs are met while in care.

The complaints’ concern more specifically is that the Administrator/Staff did not assist R1 in obtaining appropriate dental care. On 10.9.2024 at 12:25 PM LPA conducted a collateral visit at US Renal Care in Van Nuys CA. LPA met with R1 for an interview. Aside from the bruising seen on R1, LPA observed R1 teeth to be very grayish close to black.

Prior to the collateral visit LPA reviewed R1’s preplacement appraisal dated 11-02-2023, Appraisal Needs and Service plan dated 11-02-2023, Admissions agreement dated 11-02-2023, and Physicians Report dated 11-01-2023. Per the resident admissions agreement the resident is paying for assistance with meeting necessary medical and dental needs, including arranging for transportation. The pre-placement appraisal indicated R1 needs assistance with personal hygiene however it is not explained. The Appraisal Needs and Service plan does not indicate what the resident #1 (R1) dental needs were, nor was there a plan to address it. The physician’s report indicates that R1 does not wear any dentures but does need assistance with grooming. LPA did not observe any records of R1 visiting a dental professional or other appropriate skilled professional. According to R1 and dialysis staff, facility staff do not assist with oral hygiene teeth cleaning. The Administrator or Staff did not assist with contacting an appropriate skilled professional (Dentist) to address R1’s dental needs.

LPA interviewed the administrator and staff, interviews unanimously revealed they are aware of R1's tooth decay. There was no plan in place to address the issue.

Based on the observation, interviews, and records review, there is sufficient information to support the above stated allegation. Therefore, the allegation is determined to be substantiated at this time.

Exit interview conducted. Appeal rights are given.