NARRATIVE |
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32 | Continued from LIC9099
On 5/10/23, SRPD Detective verified results came back and it matched the DNA found on R1. S2 was arrested that morning, 5/10/23, and was booked into Marin County jail on two felonies. S2 was fingerprint cleared to work at the facility, training on facility policies and procedures including personal rights. S2 violated the rights of R1. This allegation is Substantiated.
There is an allegation of Neglect/Lack of Supervision - Facility failed to seek timely medical attention for resident in care. On September 4, 2022, S1 observed S2 in R1’s bathroom at approximately 1300-1330 hours. Staff working the Sunday shift did not know who to report the incident to. S1 contacted another caregiver Staff Member 3 (S3) who also reported the incident to the Activity Assistant, Staff Member 4 (S4). When S4 returned home at approximately 1700 hours, they contacted Management to report the incident. At approximately 1900-1930 hours Resident Care Coordinator and RN arrived to the facility to do a visual check of R1. The Facility Administrator contacted SRPD and Resident's family between 1800-2100 hours. R1 was not taken to the hospital until the next morning. SRPD responded to the facility the next day. Based on the suspicious nature of the incident staff failed to contact the police and ensure resident was seen timely in the ER. This allegation is Substantiated.
There is an allegation of Reporting Requirement - facility failed to report incident timely per regulations. On September 4, 2022, S1 observed S2 in R1’s bathroom at approximately 1300-1330 hours. Staff working the Sunday shift did not know who to report the incident to, staff on shift did not contact the Police based on the suspicious nature of the incident. Instead, S1 contacted another caregiver, S3, who reported the incident to S4. When S4 returned home at approximately 1700 hours, they contacted Management to report the incident. At approximately 1900-1930 hours Resident Care Coordinator and RN arrived at the facility to do a visual check of R1. The Facility Administrator contacted SRPD and Resident's family between 1800-2100 hours. R1 was not taken to the hospital until the next morning. SRPD responded to the facility the next day. Facility failed to follow the mandated reporting requirement timeframes per W&I Code 15630(b)(1). This allegation Substantiated.
Continued on LIC9099C |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
06/03/2023
Section Cited
CCR
87468(a) | 1
2
3
4
5
6
7 | 87468 Personal Rights:(a)Residents in residential care facilities for the elderly shall have personal rights... those listed in Sections 87468.1, Personal Rights of Residents in All Facilities, and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities... | 1
2
3
4
5
6
7 | Licensee to submit certification that training on Personal Rights will be conducted for all staff by POC due date of 06/03/2023. Licensee to conduct Personal Rights Training and submit a sign in sheet to CCL that includes the following: |
 | 8
9
10
11
12
13
14 | This requirement was not met as evidenced by: Based on interviews conducted and review of documents, the Licensee did not comply with the section cited above, and did not ensure the Personal Rights of R1. This poses an immediate health and safety risk to residents in care. | 8
9
10
11
12
13
14 | Date, Name/Job Role, and Signatures by POC due date of 06/12/2023. |
Request Denied
Type A
06/03/2023
Section Cited
CCR
87465(g) | 1
2
3
4
5
6
7 | 87465 Incidental Medical and Dental Care:(g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including...an apparent life-threatening medical crisis...
| 1
2
3
4
5
6
7 | Licensee to submit certification that training on Reporting Requirements will be conducted for all staff by POC due date of 06/03/2023. Licensee to conduct Training for Reporting Requirements and to review who the Administrator is and who the Designated Representative is in the absence of the |
| 8
9
10
11
12
13
14 | This requirement was not met as evidenced by: Based on interviews conducted and review of documents, the Licensee did not comply with the section cited above, and did not ensure that 911 was called for R1. This poses an immediate health and safety risk to residents in care. | 8
9
10
11
12
13
14 | Administrator. Licensee to submit a sign in sheet to CCL that includes the following: Date, Name/Job Role, and Signatures by POC due date of 06/12/2023. |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Request Denied
Type A
06/03/2023
Section Cited
HSC
15630(b)(1)(A)(i) | 1
2
3
4
5
6
7 | Welfare and Institutions Code section 15630(b)(1)(A)If the suspected... abuse occurred in a long-term care facility...(i)a telephone report shall be made to the local law enforcement agency immediately...no later than within two hours... | 1
2
3
4
5
6
7 | Licensee to submit certification that training on Reporting Requirements will be conducted for all staff by POC due date of 06/03/2023. Licensee to submit a sign in sheet to CCL that includes the following: Date, Name/Job Role, and Signatures by POC due date of 06/12/2023. |
| 8
9
10
11
12
13
14 | This requirement was not met as evidenced by: Based on interviews conducted and review of documents, the Licensee did not comply with the section cited above, and did not report suspected abuse timely. This poses an immediate health and safety risk to residents in care. | 8
9
10
11
12
13
14 | |
| 1
2
3
4
5
6
7 | | 1
2
3
4
5
6
7 | |
| 1
2
3
4
5
6
7 | | 1
2
3
4
5
6
7 | |