Complaint Investigation Report

The investigation revealed the following: Regarding allegation: Facility did not provide resident's file to resident's responsible party. It is alleged facility has not yet provided resident's file requested by responsible party. File review conducted for resident #1(R1) revealed R1 has a durable power of attorney notarized on March 16, 2017 which appoints family member #1(F1) and family member #2(F2) as the representative party. On 9/30/21 Responsible party requested a copy of R1's resident's file including care notes via email. Per administrator Irene Deanon an incident occurred in December 2020 and a new power of attorney was assigned which is why facility did not provide documents to family member #2. However, there is no additional or most current durable power of attorney for R1. Family member #3 clarify the incident but was not able to recall dates or if there was a most current power of attorney.

Based on LPA's observation and file review conducted the preponderance of evidence standard has been

met, therefore the above allegation(s) are found SUBSTANTIATED.

Regarding allegation: Facility restricted resident's physical access to visits with family. It is alleged family members were barred from physically visiting R1 within the last 71 days of R1's life. Documents reviewed revealed R1 was receiving hospice services on 5/13/21 and passed away on 5/25/21. Facility Visitation Logs revealed facility had no in person visitors on February and March 2021 and were assisting with FaceTime and Window visits by appointment. Logs for April and May 2021 show visitors log-in, R1 had visitors from Hospice Agency and Physical Therapy, no other visitors were observed. Administrator stated that due to COVID 19 guidelines family members were not visiting indoors but were assisting with window and FaceTime visits which were not logged in the visitor's login sheet. R1's file revealed note dated 3/11/21 in which facility notes directives from family member #3 restricting visitations for R1. POA notes family member #2 as R1's responsible party. PIN 21.17ASC dated March 19, 2021, Notes General Visitation Requirements for Licensees for any visitor entering the facility regardless of their vaccination status.

Based on LPA's observation and file review conducted the preponderance of evidence standard has been

met, therefore the above allegation(s) are found SUBSTANTIATED . Health and Safety Code Title 22, Division

6, Chapter 3 are being cited on the attached LIC 9099D.

Exit interview was conducted with Violeta Necesito Caregiver and a copy of the report, LIC 9099D, and Appeal Rights have been provided.