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13 | Licensing Program Analyst Michelle Reed arrived at the facility to discuss the complaint allegations. Upon arrival, LPA met with Administrator Elva Ledesma. A tour of the facility was conducted. The residents present are located in the " Patriotic and Baseball" wings of the building. There were 2 caregivers and 2 LVNs present. LVNs are present on each shift to assist staff. Interviews were conducted and records were reviewed. LPA observed residents conducting activities. Two residents were asleep in chairs and another was in her room resting. Lunch was to be served so staff did not move the residents into their bedrooms. Naps are usually taken after lunch. Residents who are incontinent are changed every two hours or as needed. Staff interviewed stated that residents may go to their rooms when they want, however, some were fall risks, so they were kept in the living room/activity room for closer observation. Currently there is 1 resident who needs to be repositioned. She is also checked every two hours and sometimes more often. Based upon interviews and a review of records the allegations are unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that staff neglect and violate resident rights. An exit interview was conducted with Administrator Lesdesma and a copy of this report was provided.
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