Complaint Investigation Report

LPAs interviewed licensee and staff #4 and conducted interviews over the phone with hospice nurse and staff #3, attempted to conduct interview over the phone with staff #4 and resident #5's responsible party. On 10/7/21 LPA Flores requested Investigator Bureau (IB) to obtain medical records for R5. On 10/26/21 LPA Flores received documents from IB investigator Veronica Padilla.

The investigation revealed the following: Regarding allegation: Facility staff did not observe changes in resident's condition. It is alleged R5 was taken to ER on 7/24/21 after responsible party found R5 "slumped over" at the dining table during an unannounced visit. Responsible party asked staff to check his blood pressure and blood pressure and heart rate were low . On 8/3/21 LPA Flores reviewed R5's physician report, resident appraisal, hospital discharge, appraisal/needs and care plan and facility's notes. Appraisal/needs and care plan notes on socialization: "low blood count: monitor for any ill effects of blood transfusion on 6/30/21 and 7/12/21: being weak/feeling tired." Hospital discharge dated 6/30/21 notes R5 was seen for a medical procedure. Facility's notes showed R5 was taken by responsible on 7/12/21 for a medical procedure. On 8/3/21 LPA attempted to interview 4 residents at the facility but was not able due to cognitive skills. On 8/19/21 LPA reviewed facility's daily assessment on 7/24/21 there are no notes for R5 at 7:00am or during 2nd shift. Per administrator R5 was under home health care services and was visited twice a week for services, administrator was informed that R5 woke up around 10:00am and was assisted with a shower due to bowel movement. Staff #3 stated to not know what occur or regarding noticing changes in condition. 4 out 4 staff were aware of R5's health condition and procedures to take in case a change is observed. Hospice Nurse stated to be at the facility for another resident and was taking notes in dinning room when R5 was sitting at table and responsible party arrived and requested 911 be contact, and was taken by ambulance around 2:00pm. On 10/26/21 LPA Flores reviewed medical records and Hospital Patient Information Sheet notes R5.

Based on LPA's document review, and interviews, conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found SUBSTANTIATED. California Code of Regulations Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Exit interview was conducted with Romina DSouza lead caregiver and a copy of this report, LIC 9099D, and appeal rights were provided.