Complaint Investigation Report

R1’s Admission Agreement was signed 02/18/2021 by both R1 and R1’s spouse. R1’s Physician’s Report from 01/08/2021 stated R1 did not have dementia or mild cognitive impairment and R1 as not being confused/disoriented.

R1’s resident records include a notarized Uniform Statutory Form Power of Attorney letter appointing R1’s spouse as R1’s Power of Attorney (POA). The letter is dated 07/14/2021. The letter grants R1’s spouse all of the powers listed in the letter, including banking and other financial institution transactions, personal and family maintenance, tax matters, real property transactions, and retirement plan transactions.

The Department also obtained copies of R1’s Resident Notes dated from 02/27/2021 until 11/12/2021. The Resident Notes document R1’s spouse, Primary Care Physician, and R1’s daughter being notified of R1’s medical and health incidents.

On 3/16/2022, LPA Marrufo conducted a telephone interview with R1’s child. During interview, R1’s child stated to have not have a Power of Attorney letter signed prior to R1 being admitted into the facility. R1’s child stated that there was an unsigned Power of Attorney letter written with his/her name, but it was unsigned because he/she did not know about the existence of the letter until approximately three weeks after R1’s death. R1’s child stated that the Power of Attorney letter was part of R1’s trust. During interview, R1’s child further stated to have not been aware of R1’s admission into the facility and did not become involved with R1’s care until R1’s spouse had been admitted into a hospital on May 4, 2021 through May 10, 2021.

On 03/16/2022 and 03/17/2022, LPA attempted to conduct telephone interviews with R1’s spouse and daughter but was unable to make contact to conduct an interview.

See LIC9099-C for more information. Page 2 of 3.