Complaint Investigation Report
On the allegation: Licensee did not ensure that changes in the resident were brought to the attention of resident's responsible person in a timely manner. LPA conducted interviews with witnesses which revealed 5/8 witnesses stating the communications concerning residents and their care has not been timely or has not been communicated at all to responsible parties. Based on the evidence this allegation is deemed Substantiated at this time.
On the allegation: Licensee did not ensure that changes in the resident were documented. LPA interviewed witnesses and staff which revealed 5/8 witnesses requested records or documentation that was not provided to them. 5/6 staff say charting and notes are being done but not on all shifts all the time and feel being shorthanded is the main reason why not all duties are completed by the end of shifts daily. Based on the evidence this allegation is deemed Substantiated at this time.
On the allegation: Staff did not meet the resident's hygiene and/or showering needs. LPA conducted interviews which revealed 5/6 staff, 5/8 witnesses and 2/6 residents stated in the memory care unit staff are shorthanded, showers are not getting completed as scheduled, Residents hair is left greasy and unwashed, residents are wearing clothing that does not belong to them and residents teeth are not being brushed. 5/6 staff stated that staffing is insufficient to get all residents services completed as scheduled, the residents are made to wait longer or refusing services due to staff running behind scheduled bathing/shower times. Based on the evidence this allegation is deemed Substantiated at this time.
On the allegation: Staff did not meet the resident's incontinence needs. LPA interviewed staff which revealed 5/6 staff stated the incontinent residents should be checked every 2 hours and due to staff being short handed the residents are waiting longer to be checked and some residents have had to wait in wet briefs. Based on the evidence this allegation is deemed Substantiated at this time.
Exit interview conducted, deficiencies cited, copy of report and appeal rights emailed to Administrator.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction