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32 | changed right before they were transported to the hospital on 10/04/2021 per facility protocol. The Hospital contacted the Administrator questioning the soiled diaper. It was explained the resident had been given an enema per physician order and the diaper had been changed prior to being sent out. The Administrator reported facility protocol is to provide incontinence care to R1 frequently as R1 has a history of ripping off their diaper. General facility protocol for incontinence care is every two hours but, in this case, it is done more frequently. R1 was described by multiple reports as being non-compliant and combative with incontinence care.
Besides the soiled diaper, the Los Alamitos Medical Center RN observed 10/01/2021 “Bruising of various stages on legs/ face, yellow bruising on bilateral shins. Purple bruises on left upper thigh. Patient has yellow bruising around left eye and purple bruise on upper lip to left side. Patient denies falling.” R1 stated in an interview with the hospital social worker that they tripped and fell while walking. Four (4) out of four (4) witnesses interviewed confirm R1 is combative, aggressive and throws themselves on the ground or into furniture. The Department’s interview with R1 was not completed due to R1’s verbal aggression and refusal. R1’s responsible party (RP) noted they had no concerns about the care provided by the facility. RP corroborated R1’s aggressive behavior as well as falls prior to admission into the facility. Due to conflicting information, the department is unable to corroborate allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence.
Exit interview conducted and a copy of this report was left at the facility. |