On 01/10/2023 LPA Calderon interviewed W1 for complaint. W1 states that W1 visited R1 facility. W1 states that W1 entered R1 room and notice dry feces on the bed sheets and floor. On 01/11/2023 LPA Calderon interviewed S1 who states that R1 room is cleaned daily, and day and night shift make sure that R1 diaper is changed at night as R1 refuses to go to the bathroom. On 01/11/2023 LPA Calderon interviewed S2 for complaint. S2 states that R1 is changed and some days R1 is nice to work with, but night shift changes R1 linens and diaper and S2 makes sure R1 goes to the bathroom. S2 states that S2 cleans R1 room and facility daily. On 01/11/2023 LPA Calderon attempted to interview R1-R2 but due to mental health issues could not ask questions of residents. On 01/11/2023 toured R1 room and noted room is clean, no feces found on the bed or on the floor. R1 bathroom is clean and well maintained.

Regarding Allegation #2: Resident was not provided with comfortable accommodations while in care.

On 01/10/2023 LPA Calderon Interviewed W1 for complaint. W1 states that staff do not afford R1 comfortable accommodations as staff do not have time to keep facility clean. W1 states that staff do not change R1 bed sheets and keep the bed clean. On 01/11/2023 LPA Calderon interviewed S1 who states that S1 provides the best accommodations possible, S1 states to provide a clean bed and facility. On 01/11/2023 LPA Calderon interviewed S2 who states that S2 works with R1 and R2 daily and provides the best care possible. S2 states to make sure that R1 accommodations are kept clean. On 01/11/2023 LPA Calderon toured the facility and found the facility comfortable and well maintained. S2 states that S2 cleans R1 room daily and cleans R1 bathroom. On 01/11/2023 LPA Calderon attempted to interview R1-R2, but due to mental health issues LPA Calderon was not able to ask questions.

On 01/10/2023 LPA Calderon interviewed W1 for complaint. W1 states that W1 visited facility and entered R1 bathroom and noticed R1 bathroom did not have toilet paper, hand soap or other cleaning supplies. On 01/11/2023 LPA Calderon interviewed S1 who states that the facility supplies all cleaning supplies and bathroom supplies for both residents need and have back up supplies in the facility. On 01/11/2023 LPA Calderon interviewed S2 who states that bathroom supplies are provided to R1 for R1 needs. S2 states to provide all cleaning supplies residents will need. On 01/11/2023 toured the facility with S1, LPA Calderon inspected R1 bathroom and noted bathroom supplies, also noted cleaning supplies located in the garage. On 01/11/2023 LPA Calderon attempted to interview R1-R2 but due to mental health issues residents were not able to answer any questions regarding the complaint.

On 01/10/2023 LPA Calderon interviewed W1 who states that W1 had visited R1 and walked into the kitchen and noticed that the sink was clogged and had dirty water that was in the sink with dirty plates and cups. On 01/11/2023 LPA Calderon interviewed S1 who states that the kitchen sink was clogged and backed up, but within 24 hours maintained fixed the sink and the sink is now working, and all dishes are cleaned. On 01/11/2023 LPA Calderon interviewed S2 who does state that the kitchen sink was not working for 24 hours and S2 called S1 who had facility maintained fix the kitchen sink. On 01/11/2023 LPA Calderon toured the facility with S1, LPA Calderon entered the kitchen and noted the kitchen sink was working and all dishes were cleaned.

Regarding Allegation #5: Staff mishandle the resident’s medication while in care.

On 01/10/2023 LPA Calderon interviewed W1 who states that W1 visited R1 and noted a medication pill was found on the ground inside R1 room and dining room area. On 01/11/2023 LPA Calderon interviewed S1 who states that no resident family has advised S1 of any medication errors, medication missing or found on the ground in residents’ room or in the dining room. On 01/11/2023 LPA Calderon toured the facility with S1, LPA Calderon did not see any medications on the ground. On 01/11/2023 LPA Calderon interviewed S2 who states that S2 has not seen any medication on the ground and if there is missing medication S2 updated residents’ medication log. On 01/11/2023 LPA Calderon reviewed R1 medication log, LPA Calderon did not see or note any missing medication noted for R1. On 01/11/2023 LPA Calderon attempted to interview R1-R2, but due to mental health issues LPA Calderon was not able to ask residents any questions on their medications or if any medication was found on the floor.

On 01/10/2023 LPA Calderon interviewed W1 for complaint. W1 states that staff have not been trained to work with R1 who has special needs. W1 states that R1 needs one to one care and staff have not been trained for one-on-one care due to staffing issues. W1 states that staff cannot give the best care possible and cannot be given the training needed. On 01/11/2023 LPA Calderon interviewed S1 who states that all staff are given training to care for residents with special needs and that R1 does not need one to one care. S1 state that all staff are trained for CPR, diaper changes and cleaning. On 01/11/2023 LPA Calderon interviewed S2 who states that R1 needs changes from day to day but that R1 does not need one for one care. S2 states that S1 has given training for resident’s care. On 01/11/2023 LPA Calderon reviewed needs and service plan and physician report, LPA Calderon noted R1 does not need one to one care. On 01/11/2023 LPA Calderon attempted to interview R1-R2, but due to mental health issues R1-R2 could not answer any questions regarding complaint.

On 01/10/2023 LPA Calderon interviewed W1 for complaint. W1 states that W1 has visited R1 and notice that R1 was not clean, was wearing dirty clothes, W1 states that staff cannot handle R1 one to one and S1 needs to hire more staff to care for residents. On 01/11/2023 LPA Calderon interviewed S1 who states that R1 is given a shower daily, clothes are and groomed by staff while in the facility. On 01/11/2023 LPA Calderon interviewed S2 who states that R1 sometimes refused to be given a shower or clean her body. S2 states that R1 is given a shower every day and her diaper is changed daily. S2 states that resident is groomed and R1 clothes are cleaned weekly. On 01/11/2023 LPA Calderon attempted to interview R1-R2, but due to mental health issues R1-R2 could not answer any questions regarding complaint.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegation of Residents room not properly maintained, resident was not provided with comfortable accommodations while in care, residents bathroom was not provided with supplies,, facility sink is in disrepair, staff mishandle the residents medication while in care, staff are not being properly trained, resident was not properly groomed while in care is found to be UNSUBSTANTIATED.

An exit interview was conducted and copy of the Complaint Report was provided to the Administrator S1.