Complaint Investigation Report

LPA Jensen interviewed care provider Stephanie Siewe. She stated that sometimes the refrigerator functions properly and sometimes it does not. When the Administrator is present he can usually set the circuit breaker in order to make it function properly. LPA Jensen instructed care provider and cook to discard all food product from the malfunctioning refrigerator.

LPA Jensen interviewed 3 residents and 1 responsible party. 2 residents were interviewed in their rooms and 1 resident and one responsible party was interviewed outside.

LPA Jensen observed stains on the walls in a bedroom and chewed sunflower shells behind a night stand in the same room. LPA Jensen also observed a discarded mattress and damaged chairs being stored in the back yard. LPA Jensen attempted to interview a resident in a resident bedroom privately but was unable to shut the door as it was broken. The door was either out of alignment or had expanded beyond the size of the door frame and would not shut properly. LPA Jensen observed blood on the linen of resident sheets and pillow case. In the dining room by the wall with the clock, on the floor next to the hallway LPA Jensen observed approximately 20 half inch diameter stains on the floor and food remnants.

LPA Jensen detected an odor of urine emanating from a residents room. LPA Jensen also detected an odor of urine during the course of site visits on 3/6/23 and 3/9/23.

Deficiencies are being cited from the California Code of Regulations (CCR) Title 22, Division 6. Failure to correct deficiencies may result in the assessment of civil penalties.

An exit interview was conducted and a copy of this report and appeal rights were provided to care provider Stephanie Siewe.