Complaint Investigation Report

R1 also observed that another resident is always brought down to the dining room late for their meals.

Resident 2 (R2) also had concerns about staff responding to calls for assistance. R2 says when you use the call button the staff don’t respond.

During the initial visit August 30, 2024, LPA Haley pulled a pull cord in the men’s restroom on the third floor. No staff member ever responded. LPA Haley set a timer and after about 16 or 17 minutes LPA Haley showed S1 and S2 the timer and explained the pulled cord was pulled over 15 minutes ago. Both staff members acknowledged no one responded to the call. S1 explained that staff was scolded and were told they were not responding to the one’s in the bathroom. S2 said they did not receive the notification, but it goes to the caregivers that have the phone. S2 said they're not sure if the pull cord was working or the staff just forgot to respond.

Although it’s unclear if the failure to respond to pull cords/call buttons is related to a lack of staffing or caregivers forgetting to respond, it is clear that on more than one occasion calls for assistance have been answered late or not responded to at all.

Based on the evidence gathered through interviews and LPA observations, the preponderance of evidence standard has been met, therefore, the allegation above is found to be SUBSTANTIATED. A violation is being cited per California Code of Regulations Title 22.

An exit interview was conducted, and a copy of this report and appeal rights was provided.