Golden Pond Retirement Community

Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection at Golden Pond Retirement Community on 9/26/23 at 9:00am to inform the licensee of complaint allegation mentioned above and to deliver findings. During this investigation LPA Gould interviewed S1 (See confidential name list LIC-811 dated 9/26/23) and reviewd records for deceased resident identified as R1.Based on the interviews and statements obtained during the investigation process, the allegation has been corroborated as the facility did obtain an updated Physician Orders for LIfe Sustaining Treatment (POLST) on 8/5/23 and the information was not correclty provided to all staff members and departments for awareness and appropriate treatments identified by R1. Report Continued on LIC 9099-C SubstantiatedRead the full finding— CDSS inspection report, September 26, 2023 · control 27-AS-20230922103831

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to Golden Pond Retirement Community (RCFE) on 6/29/23 at 1:45pm to amend the report for the investigation of the above allegation and to deliver the findings. LPA met with facility staff and together discussed the investigation details. This report is being amended due to an error discovered in the investigation conducted by the department which resulted in a erroneous determination of the findings. Based on the interviews and documentation obtained during the investigation process, the allegations are substantiated. The department has determined, the deceased resident did have diagnosis of dementia per her Physician's Report dated 4/26/21. Per title 22 regulations, for resident's with a diagnosis of dementia, items such as matches or cigarettes shale be stored inaccessible to residents in care. Per previous interviews conducted by the department, the former residents cigarettes were not stored inaccessible to tRead the full finding— CDSS inspection report, June 29, 2023 · control 27-AS-20221229095800

Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection at Golden Pond Retirement Community (RCFE) on 3/30/23 at 8:40am to inform the licensee of complaint allegation mentioned above. During this investigation LPA Gould interviewed two staff members and three residents. LPA conducted a walkthrough of the facility and inspected two resident rooms and both food service and preparation areas in the facility. LPA observed no signs of insect infestation. report continued on LIC 9099-C Unsubstantiated— CDSS inspection report, March 30, 2023 · control 27-AS-20230327163846

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to Golden Pond Retirement Community (RCFE) on 6/29/23 at 1:45pm to amend the report for the investigation of the above allegation and to deliver the findings. This report is being amended due to an error discovered in the investigation conducted by the department which resulted in a erroneous determination of the findings. A new report will be generated that supersedes this report. Substantiated— CDSS inspection report, March 30, 2023 · control 27-AS-20221229095800

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to Golden Pond Retirement Community on 3/22/23 at 9:00am to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations have been corroborated by the department. On 10/10/2022, at 8:58pm, Resident (R1) pressed their call pendant for assistance to the restroom. R1 stated they waited approximately 15 minutes for staff who never arrived. R1 could not wait any longer and attempted to go to the restroom on their own. R1 stood up and sustained an unwitnessed fall and hit his head on an unknown object. Per AlphaOne Ambulance records, they were called at 10:48pm. It is unknown when exactly R1 was found by staff, but staff stated they did call 911 once R1 was found. R1 was on the ground for approximately 35 minutes from the timeRead the full finding— CDSS inspection report, March 22, 2023 · control 27-AS-20221104162120

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to Golden Pond Retirement Community on 11/4/22 at 9:00am to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated. LPA conducted interviews with reporting party and six (6) staff members who could not corroborate the allegations. Per interviews conducted, no staff members interviewed reported any prior knowledge that a staff member was in an infectious state prior to beginning of staff member's shift. The staff who eventually tested positive for an infectious disease did not seek out treatment prior to or had any concerns prior to being informed of positive status. Per interviews, when a staff member attempted to call off work, the staff who received the disclosure was concerned of other inRead the full finding— CDSS inspection report, November 4, 2022 · control 27-AS-20220808094023

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to Golden Pond Retirement Community on 11/4/22 at 9:00am to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated because LPA was unable to verify there was an alleged victim. LPA attempted to contact reporting party who did not respond to requests for interviews. The complaint received did not identify a victim in the complaint and LPA was unable to connect the complaint to any current resident. LPA conducted interviews with five (5) staff members and no staff member interviewed had received any complaints from residents regarding inappropriate staff behavior. LPA was unable to corroborate the allegations or identify a potential victim at the facility. Report Continued on LIC 9099-C UnsubsRead the full finding— CDSS inspection report, November 4, 2022 · control 27-AS-20220915145941

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Golden Pond Retirement Community (RCFE) on 5/6/22 at 1:00pm to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details. LPA conducted additional interview with staff members. Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated because LPA received conflicting statements from both staff, and family members interviewed. The department has determined that although family members provided home made food for a resident, ultimately it is the resident's choice as to what food he or she eats and the resident has the personal rights to eat meals provided by the facility instead of a family member's prepared food. The department and the facility cannot comply with a request that resident only eat food prepared by family members and not facility foRead the full finding— CDSS inspection report, May 6, 2022 · control 27-AS-20220216110214

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Golden Pond Retirement Community (RCFE) on 5/6/22 at 1:00pm to conclude the investigation of the above allegation and to deliver the findings. LPA met with Administrator and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations have been corroborated because two family members and staff members interviewed confirmed staff did not provide resident's prescription medication according to physician instructions. All witness interviewed stated there were dates when resident's blood glucose monitoring and insulin administration were administered past the time identified in the physician's instructions. The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation of Medication is substantiated but if any additional information is received this complaint caRead the full finding— CDSS inspection report, May 6, 2022 · control 27-AS-20220317105126

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Golden Pond Retirement Community RCFE on 10/13/21 at 9:00am to interview R1, conclude the investigation of the above allegation and to deliver the findings. LPA met with Administrator and together discussed the investigation details. Based on the interviews conducted and statements obtained during the investigation process, the allegations cannot be corroborated because Resident #1 (R1) (see confidential name list LIC-811 dated 10/13/21) denied the facility denied R1's physical or occupational therapies and identified that all therapies took place outside unless it was too cold outside and R1 declined to have the therapy outside with family. LPA also conducted interviews with RP and PT. PT also denied that the facility denied access to the resident and also denied the allegation that the facility changed the location of the therapies. PT states that on one day there was confusion regarding the location frRead the full finding— CDSS inspection report, October 13, 2021 · control 27-AS-20210913144609