Complaint Investigation Report

On the allegation: “Licensee does not allow residents to choose their own third-party health care provider”, it was alleged that an outside physician affiliated with a hospice agency conducted assessments on several residents without their knowledge or consent. During the investigation, it was revealed that the Marketing Director and a hospice nurse requested copies of residents’ care plans for residents they believe may meet the criteria for hospice admission. Interviews conducted with residents revealed that a physician visited the facility to evaluate whether they qualified to receive additional assistance from outside nurses that are not employed by the facility. Residents stated that facility informed them that the assessment was intended to determine whether they would benefit receiving additional care services. However, residents reported they were not informed that the assessment could result in admission into hospice services if they qualified. Interviews further revealed that the residents, who were their own responsible parties at the time, did not participate in the decision to have the assessment conducted. Additionally, information obtained during the investigation revealed that the facility did not provide residents with a list of hospice agency options or allow residents to select a hospice provider of their choice. The facility arranged for one hospice particular agency and physician to conduct assessments. LPA interviewed a family member of one resident who confirmed that the assessment was conducted without the family’s knowledge and without approval or referral from the resident’s primary physician referral. Based on the information gathered during the investigation, the department has sufficient evidence to confirm this allegation occurred. Therefore, the allegation of “Licensee does not allow residents to choose their own third-party health care provider” has been SUBSTANTIATED at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 9099-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.