A review of Title 22, section 87217 (b) Safeguard for Resident Cash, Personal Property, and Valuables indicates: “Every facility shall take appropriate measures to safeguard residents’ cash resources, personal property and valuables which have been entrusted to the licensee or facility staff.” Additionally, on 4/11/2023, a review of the Wellness Care Theft and Loss Policy revealed the policy and procedures of lost or stolen items as well as R1’s family member’s initials on the form as acknowledgement on 12/23/2020. Lastly, a review of Section 1569.152 (a) of the Health and Safety Code indicates that : “ A residential care facility for the elderly, as defined in Section 1569.2, which fails to make reasonable efforts to safeguard resident property shall reimburse a resident for or replace stolen or lost resident property at its then current value.

R1’s family member indicated the wedding ring was last seen in October 2021, while the facility staff members stated it is unknow when the wedding ring went missing. Although the facility stated they attempted to reach the family for reimbursement of the lost or missing valuable, the facility did not safeguard R1’s personal property as the wedding ring was inventoried in the LIC 621 Resident Personal Property and Valuables form and has been missing ever since. Thus, the allegation, facility did not safeguard residents’ personal property while in care is deemed Substantiated at this time.

1 citation was observed during today’s visit.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited

Although R1’s family member stated they were not made aware of the skin growth on R1’s chest, documentation and interviews confirmed that facility staff conducted an appointment and documentation to provide the proper treatment and care for R1. Based on evidence gathered, the allegation is deemed unsubstantiated at this time.

Regarding the allegation: Staff are not meeting a resident's hygiene needs. On 12/22/2021, starting at 2:13 p.m., LPA Ascencio and LPA Rosales conducted an interview with Staff #1 (S1). Interview with S1 revealed that all the resident at the facility are on a twice (2) a week shower schedule. If resident refuse a shower, they next shift will help to provide that shower. If that does not work, we try the following day. Additionally, all residents get their hands washed or disinfected with hand sanitizer. We have a podiatrist that comes in at least one (1) time a month. When they refuse that service, the podiatrist will add them to the schedule for the following visit. S1 continued, regarding R1, they constantly refused services. We would attempt various times to provide showers, the podiatrist attempted various times, but R1 would become agitated and refuse. A file review was conducted on 4/11/2023 which revealed that on 01/07/2021, R1 was seen and treated by the podiatrist. Additionally, on 06/01/2021, the podiatrist attempted to treat R1 on three (3) separate occasions but refused any care. Other charting notes were observed where R1 refused podiatric care in September and November of 2021.

Continued on LIC 9099 - C

Interview with various residents 04/26/2023, confirmed that a podiatrist comes to the facility and treats their finger and toenails. Additionally, interviews also confirmed that they are assisted with showers at least two (2) times a week, and other grooming assistance when it is needed. Lastly, interviews with residents revealed that they are happy and satisfied with the hygiene assistance and needs the staff provide.

Although R1’s hygiene needs may not been met fully due to behaviors presented, documentation revealed R1 was treated one time, and refused at others for podiatric care. In addition, interviews with residents revealed that residents are happy with the hygiene care they are receiving. Although the allegation may have occurred, there is insufficient evidence to prove that the staff did not meet R1’s hygiene needs. Thus, the allegation is unsubstantiated at this time.

Regarding the allegation: Resident had access to medication without authorization. On 12/22/2021, starting at 2:13 p.m., LPA Ascencio and LPA Rosales conducted an interview with Staff #1 (S1). Interview with S1 revealed that R1 was on medication management due to a diagnosis of dementia. S1 added that, upon R1’s arrival, the facility received a document from R1’s physician indicating the dementia diagnosis and that R1 is not able to tend to their medication needs. S1 added that every resident at the facility is on medication management and that the medication technician provides the assistance of self-administration of medication. Lastly, S1 elaborated on the process of medication management and self-administration procedure.

A file review was conducted on 4/11/2023 which revealed R1’s care plan indicating that staff members will obtain physicians orders and dispense medication accordingly. Additionally, the LIC 602 Physician’s Report indicated that the resident is unable to manage medication. A copy of R1’s Medication Administration Record (MAR) was observed and indicated all medication was properly administered and recorded for the months of November and December 2021. Additionally, six (6) resident MAR’s was observed and indicated all medication was properly administered and recorded for the month of April 2023.

Continued on LIC 9099 - C

Although R1 was observed to pull out a handful of medication by R1’s family member, interviews with staff indicated they have not observed medication in common areas or in resident’s personal belonging, while resident interviews indicated that they have not had any problem with the self-administration of medication. Although the allegation may have happened, there is insufficient evidence to prove that resident had access to medication without authorization. Thus, the allegation is deemed unsubstantiated at this time.

Regarding the allegation: staff does not provide adequate supervision to the residents. Interview with R1’s family member on 04/25/2023, starting at 4:30 p.m. revealed that on 12/07/2021, R1’s family member was visit R1 and as they were leaving the facility, a resident stopped the family member and started to attack them. R1’s family member stated they attempted to call for a staff member, but no staff was present. After some time, a staff member got involved and separated the resident from R1’s family member. Lastly, R1’s family member stated it was the only time they observed a behavior like this and was shocked no staff was around to assist. Resident interviews on 04/26/2023, revealed that they have not observed any alterations between other residents, staff on residents or staff on staff. Additionally, residents stated that staff are available at all times to assist if there were to be a problem. Lastly, resident interview indicated they feel safe and comfortable living at the facility. That same day, starting at 1:32 p.m., staff interviews revealed that they have not witnessed any altercations within the facility. Staff stated that there are residents that present with various behaviors but are not violent or threatening.

Continued on LIC 9099 - C

Although R1’s family member stated they were involved in an incident with a resident and no staff was present, staff denied observing any altercation between residents, and indicated the process if a situation were to occur while resident interviews indicated feeling safe living at the facility. Although the allegation may have happened, there is insufficient evidence to prove the allegation occurred. Thus, the allegation of staff does not provide adequate supervision is deemed unsubstantiated at this time.

Lastly, regarding the allegation, resident sustained a fall while in care. Interview with S1 on 12/22/2021, starting at 2:13 p.m. revealed that R1 did not require any assisted devices to ambulate throughout the facility. The only time R1 used a wheelchair was when R1 sustained a pelvic fracture in May of 2021 but required no surgery. Additionally, S1 added that due to R1’s behaviors, there were days R1 was observed to be lethargic during walking because of medication. There were other days were R1 was agitated, combative and refused any help from staff causing R1 to pace around the facility. Due to these unknown day to day behaviors, R1 had some falls while at facility. S1 added that R1’s last fall happened the day before they moved out of the facility. It is unknown how they fell but it happened during dinner time. We are thinking R1 was getting ready to sit at the table and either tripped or missed the chair, falling to the ground. Lastly, S1 elaborated on the process and procedure if a resident experiences a fall and how to minimize the possibly of a fall. Staff interviews on 4/26/2023, also elaborated on the procedure of a fall and how to minimize falls for every resident.

A file review was conducted on R1’s medical chart on 04/11/2023. According to R1’s LIC 602 Physician report, R1’s primary diagnosis was wedge compression fracture of T5-T6, Multiple fractures of ribs and Dementia. Additionally, the LIC 602 stated that R1 required stand-by assistance with bathing, grooming, and toileting needs, while needing setting up for self-feeding. According to the Wellness Care Senior Living Care Plan, R1 was admitted 12/23/2020, was independent or needed stand-by assistance with transfers, mobility, eating, toileting, bathing, dressing, and grooming.

Continued on LIC 9099 - C

Interview with R1’s family member on 4/25/2023, starting at 4:30 p.m., confirmed that R1 had a fall on 12/06/2021 during dinner time. R1’s family member added that they were notified of the fall and the transportation of R1 to the hospital.

Although the R1 had a fall, the Department understands that falls cannot be prevented only minimized. According to staff interviews, the facility attempts to minimize fall risk by proving two (2) hour checks, stand-by assists and de-cluttering a resident’s room. Therefore, there is insufficient evidence to prove that the resident fell due to the lack of care and supervision by the facility. Thus, the allegation is deemed unsubstantiated at this time.

LPA Ascencio communicated with Administrator Hernandez regarding the findings and areas of concern pertaining to addressing medical needs, medication, and care and supervision. Administrator Hernandez stated continued improvements and striving to provide the best quality of care for residents at the facility.

Exit interview conducted and copy of the report was issued to Administrator.