Complaint Investigation Report
“Resident is not provided medications as prescribed” – R1 is receiving hospice services (admitted 11/13/2025). Hospice Nurse confirmed R1’s care was adjusted under physician’s orders for comfort-focused treatment, including discontinuation of blood glucose monitoring and EpiPen use. Medications are aligned with hospice plan of care. No evidence was obtained of medication mismanagement or failure to administer prescribed medications.
“Resident is not provided appropriate meals/special diet as required” – Records reviewed indicated R1’s dietary plan was adjusted under hospice physician orders for comfort care. No special or restricted diet was identified. Observations did not identify concerns with meal service. No evidence supported the allegation.
“Resident is not provided appropriate incontinent care” – Staff reported assistance is provided with toileting needs. LPA conducted a facility tour and interviewed staff, who confirmed bedpans are not used for R1 or other residents. No concerns were observed during the visit. No evidence indicated care was not provided.
“Resident is forced to stay in bed” – Staff reported R1 has mobility limitations and may refuse to get out of bed, and is encouraged to participate in activities as tolerated. Documentation provided showed resident engagement in activities. Observations did not indicate residents were confined to beds. No evidence supported the allegation.
“Violation of resident’s personal rights” – Allegation involved an unknown male entering R1’s room inappropriately. Staff interviews and observations did not identify any such incident. R1 denied the allegation. No evidence was obtained to substantiate the claim.
Based on interviews conducted, observations made, and information obtained, these allegations are Unsubstantiated . A finding that the complaint is Unsubstantiated means there is not a preponderance of evidence to prove the alleged violation occurred.
Exit interview conducted. Report discussed and provided to Administrator. Signature confirms receipt.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction