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32 | The investigation consisted of the following: During the initial visit conducted on 03/03/2026, LPA Sanjay Vaid conducted an unannounced visit and obtained copies of the resident and staff rosters, documents for Resident #1, and six (6) random residents, resident shower schedules, resident shower refusal logs for February to present, monthly menus, and Interviewed Staff #1-#3 and Resident #1-#4. During today’s visit, LPA Gutierrez checked kitchen food supply, toured six (6) random resident bedrooms, obtained staff roster, resident roster, reviewed R1’s file and obtained copies of R1’s service plan, family meeting notes, and shower schedule. LPA also obtained facility food menu, resident council meeting notes, and requests from Administrator to email a copy of Aprils housekeeping schedule for all employees worked. LPA interviewed Administrator, staff #1-staff #8 (S1-S8), and residents# 1-residents #7 (R1-R7). During today’s visit LPA delivered findings.
In regard to the allegation” Staff are not ensuring residents’ needs are being met”, It is alleged that staff did not follow R1’s care plan for showering. During interviews with Administrator and staff two (2) staff stated that residents are getting showered according to their shower schedule .Two (2) staff indicated there are times that they miss scheduled showers because they are either short staffed or they don’t have clean towels During interviews with residents four (4) out of seven (7) stated that they do not need assistance with showers. One (1) R7 stated that he/she gets showered every day because that is there rights and they had assistance from CCLD to enforce that right. One (1) resident R1 stated they need to ask for showers and one (1) resident stated they ask for help occasionally and need to wait. During record review it was reviled that occurring to R1’s care plan they are to be showered twice a week, LPA obtained shower logs for the month of February and R1 should have been showered a total of eight times long indicated four showers, one refusal shower, and three missed showers from staff. LPA also collected notes from a meeting with facility staff and family dated 02/06/2026 indicating showers were to be given twice a week and two showers were missed after that meeting. It could not be concluded that the facility failed to follow R1’s care plan since there was documented evidence that R1 refused to be showered at times, and the facility maintained a shower log and documentation during these occurrences. Finally, of the residents interviewed, no residents stated they were not being provided with shower assistance nor was there any evidence confirming any resident had not been provided with a shower for thirteen days
“Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.An exit interview was conducted, and a copy of this report and appeal rights was given to Paul Gonzon.
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