Complaint Investigation Report

Allegation: Facility failed to follow resident’s Advanced Health Care Directive.

It is alleged the facility was not providing information to an Agent, on the Advanced Health Care Directive, regarding a resident’s care in 2019.

During the file review of R1’s resident file, LPA reviewed the Identification and Emergency Information (LIC601) licensing form. LPA found only (1) contact listed on this form. The initial form was filled out on 11/08/18 and signed by R1 upon admission. During file review, LPA observed R1’s Advance Health Care Directive listed (2) emergency contacts (co-agents). Upon additional review if the Advance Health Care Directive, states that the two listed “shall make decisions for me in accordance with what my agent determines to be in my best interest” (pg.2). During reviews of Resident R1’s Service Notes, LPA observed that R1's daughter was informed of incidents in 2019. LPA also observed a note which indicates that former Director of Wellness Meriza De La Cruz got clarification from R1's fiduciary about R1's Advance Health Care Directive 0n 05/02/19. Fiduciary clarified to facility staff that both R1's son and daughter are on her Advance Health Care Directive and that if there is a major medical condition R1's son will respond right away as he lives a few minutes away from the facility and R1's daughter lives in Northern California. LPA observed in the notes that the daughter was added to the Identification and Emergency Information form as well as the fiduciary per the daughter’s request. Additionally, LPA observed that R1’s son and daughter were notified regarding care and treatment of R1.

During interviews with Staff (S1-S4) four (4) out of four (4) stated if there are co-agents listed on the Advanced Health Care Directive, they notify both agents