Complaint Investigation Report

It was learned that R1 eventually was diagnosed with dementia and was moved over to the memory care portion, Traditions, of this facility at a later date. This diagnosis was reflected on the LIC 602 that was completed on 02/20/2024.

Based on a review of the forms and documents that were gathered during the course of this investigation, it was learned that this resident, R1, had already lost their dentures from a prior incident that took place earlier in their placement to this facility.

It was learned that there was a second incident that took place where the resident was unable to recall where their dentures were last seen and their family and responsible party were made responsible in replacing them again.

Based on interviews conducted during the course of this investigation, it was learned that the staff were tasked with making sure that proper oral hygiene and care were to be maintained on a daily basis for R1. This task was outlined and implemented on the daily tasks assignment for R1. After the completion of each assigned task, facility personnel would then initial to note that the task had been completed. It was learned that facility staff were unaware as to how the dentures for R1 would have gone missing and did not have a plausible reason at this time.

As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

Appeal rights were printed and a copy was left with the facility designated Administrator at this time.