The complaint alleges that R1, who resided in the facility at the time of the complaint, needs a higher level of care than can be provided in a Residential Care Facility for the Elderly (RCFE) setting. LPA reviewed documents for R1, including but not limited to physician’s report, needs and service appraisal, and hospital discharge records. Record review revealed that R1 initially moved into the facility on 02/17/2023, following a hospitalization. Preplacement appraisal found in R1’s facility file was left blank. A care assessment and service plan was filled out by the facility’s Resident Care Coordinator on the date of R1’s admission, however the document is not signed by R1 nor their responsible party. The document is also incomplete, does not address R1’s functional capabilities and R1’s mental condition indicates “A/O x2” with no additional information provided. R1 was hospitalized prior to admission. LPA reviewed hospital discharge records dated 02/12/2023, which indicate R1’s diagnoses include, but not limited to: generalized anxiety disorder, major depressive disorder, psychotic disorder, and pressure ulcer. R1 resided at the facility and was hospitalized on 04/03/2023 following a reported incident of suicidal ideation. Hospital discharge records indicate “discharge now, intermediate care facility.” Even though Aasta is licensed as an RCFE and as thus cannot accept or retain any resident that requires intermediate care, R1 returned to the facility the same day. R1 was again brought to the Emergency Department on 04/11/2023 with a diagnosis of infected cyst and a skin infection. Again on 04/14/2023 and 04/17/2023, R1 returned to the Emergency Department on both dates with an infected open wound noted. Record review revealed that R1 was then subsequently hospitalized from 05/30/2023 to 07/28/2023 and R1 was readmitted to the facility on 07/31/2023. A care assessment was completed upon readmit but again was not signed, so it is unclear whether the care assessment was reviewed with R1 or their responsible person. No pre-admission appraisal was completed upon re-admit. Hospital records reflect R1 was treated in the Emergency Department on 08/14/2023 after R1 fell at the facility. On 09/07/2023, a credible witness visited the facility and reported that R1 “has psychiatric illness and is taking anti-psychotic medications. The medications do not seem to be effective.” The credible witness initiated an evaluation into R1’s capacity for self-care and indicated R1 scored 0/8, meaning R1 is incapable of completing any self-care tasks, which is a prohibited health condition. Interview with staff revealed R1 has needs outside the scope of typical RCFE residents, and staff are unable to meet R1’s needs. R1 was again hospitalized for psychiatric service on 09/10/2023. Record review revealed that R1 was again readmitted to the facility on 10/12/2023. Based on interview and record review, there is sufficient evidence to support the allegation, therefore, the allegation “facility is retaining a resident needing a higher level of care” is deemed SUBSTANTIATED at this time. Report Continued on LIC 9099-C (p.3)

The complaint alleges that R1’s hygiene needs and home health needs were not met, as R1’s body as well as their facility room was observed dirty, with dirty sheets and a malodorous smell in R1’s private resident room. A credible witness documented that R1’s hair was greasy and body odor was noted during a facility visit on 09/07/2023. The credible witness also indicated there was a strong foul odor in the room. R1 was reported to be curled in a fetal position on their bed, difficult to rouse and did not wake up or engage, although staff and the credible witness were attempting to communicate with R1. Staff interviews revealed that R1 regularly refused care, including assistance with basic hygiene as well as home health provided wound care. Interview with Administrator revealed that Administrator reported the concerns related to self-neglect to APS as well as to the resident’s physician. Administrator stated they had attempted to contact R1’s family member, but R1’s family member was not returning the facility’s calls. LPA requested documentation of these various contacts, however no written proof was provided. LPA reviewed documents provided by APS, which did not include any information indicating the facility filed a report for self-neglect. Additionally, while fax communication with R1’s pharmacy was provided, there was no proof of communication with R1’s physician related to R1’s refusal of care. Based on interview and record review, the allegations “Licensee did not ensure resident’s hygiene needs were met” and “Licensee did not ensure home health needs were met” are deemed SUBSTANTIATED at this time.

Allegation: “Licensee did not ensure resident’s medical documents were complete:”

The complaint alleges that R1’s medication log was not completed and also alleges that R1 was incapable of making their own decisions but did not have a medical Power of Attorney (POA) on file with the facility. Interview with facility staff and Administrator confirmed R1 did have a POA which designated R1’s family member authority to make decisions related to R1’s finances, however, R1 did not have a POA related to medical decisions. The facility did not retain a copy of any such POA document. Additionally, as outlined above, the facility did not obtain a pre-admission appraisal upon any of R1’s admits to the facility. R1 only had one Admission Agreement in their file, which was not signed nor dated, as the only date on the document indicates date of occupancy 10/12/2023, and the document was missing pages. Blank documents in R1’s file included the pre-admission appraisal, personal property and valuables, personal rights, and release of medical information. R1’s care assessment and service plans were incomplete and R1’s MAR was Report Continued on LIC 9099-C (p.4)

Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 9099-D). Failure to correct the deficiencies may result in civil penalties.