Carson Senior Assisted Living

Allegation investigated: Resident's needs are not being met. Resident left in soiled clothing for a long period of time.

On 07/16/21, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced subsequent complaint visit at this facility. LPA met with Ginger Enriquez, Administrator, and explained the purpose of today's visit is to conduct additional interviews and to deliver findings. The investigation consisted of the following: LPA interviewed Ginger Enriquez. Interviews were conducted with four (4) staff, three (3) witnesses, and fourteen (14) residents. LPA inspected the facility. LPA reviewed copies of service records concerning (R1) along with the current staff/resident roster and other documents in association with the allegation. A reveiw of (R1's) medical records and police report were performed. Evaluation Report continues on LIC9099-C Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Resident's needs are not being met. Resident left in soiled clothing for a long period of time. It is alleged the staff is not meeting resident #1 (R-1’s) needs and was left in soiled clothing for an extended period. The complainant (W-1) claims (R-1) needs were neglected and were left in soiled clothing for more than 24 hours. An interview with staff #1-#4 (S1-S4) all argues this claim. The administrator (S-1) stated caregiver’s responsibility is to assist the residents with activities of daily living (ADL). Caregivers could be responsible for up to 10 residents at one time. When a caregiver is notified of a diaper or bedding change, the caregiver will address the matter within 30 minutes. Moreover, caregivers are trained to use aided equipment to help maneuver residents who are heavy to clean them. (S-1) claims in the situation with (R-1) who was ambulatory and was medically evaluated as independent when admitted on 01/13/20. (S-1) claims that (R-1) was being assisted by caregivers only as required and when requested by (R-1). (S2-S4) reported there were occasions when (R-1) refused assistance with toileting, diaper changes, or medications when it was readily available. (S2-S4) all verified residents are monitored at least three times during each shift within the eight hours. (S2-S4) further asserted, it would be improbable to have (R-1) in soiled clothing for more than 24 hours by all three work shifts. Interviews with residents #2-#11 (R-2-R-11) all claimed they had no problems with the staff and found them to be attentive and responsive to their care and needs. Residents #12-#14 (R12-R14) had concerns with how infrequently the staff monitor or changed their diapers. However, a review of “Resident ADL 2-Hour Check List ” disputes their statements. Nonetheless, (R2-R14) were all unanimous to state the staff has not left any resident in soiled clothing for 24 hours. Furthermore, (R2-R14) felt their care and supervision are being met and were complimentary of the staff. An interview with witness #3 (W-3) power of attorney to (R-1) claims, (R-1) was at the lowest level of care, which meant the resident can do all her own (ADLs). (W-3) included the staff at this facility did their best. The staff went above and beyond what was expected and that (R-1) was not charged fees for the extra services performed. (W-3) reported that (R-1) had multiple health issues that caused her daily discomfort and found it was more natural to blame others that were willing to help. There were no statements from (R-1) as she was not available for an interview. Evaluation Report continues on LIC 9099-C The Department conducted a review of the Los Angeles County Sheriff’s Department report (W-2) and had determined no victims of elder abuse were found. The Department’s investigation consisted of an inspection of the facility, observation, review of (R-1’s) service records, incident report, ADL Check List Log, Medical Records, along with interviews of staff, residents, and witnesses were conducted and found no evidence to support the allegations mentioned above. Based on information gathered, the Department did not find sufficient evidence to support the allegations: "Resident's needs are not being met", "Resident left in soiled clothing for a long period of time". Although the allegations may have happened or are valid, there is not enough preponderance of evidence to prove the alleged allegations are valid did or did not occur. Therefore, the allegations are "unsubstantiated.” No deficiencies were cited. An exit interview was conducted with Ginger Enriquez, and a hard copy was provided via email.the state’s words, verbatim · CDSS document, Jul 16, 2021 · control 11-AS-20201214161442

Allegation investigated: Resident was left on the ground for an extended period after falling. Resident care needs are not being met.

On 07/13/21, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced complaint visit at this facility. LPA met with Ginger Enriquez, Administrator, and explained the purpose of today's visit is to conduct interviews and to deliver findings. The investigation consisted of the following: LPA interviewed Ginger Enriquez. Interviews were conducted with five (4) staff, (1) witnesses, and (10) residents. LPA inspected the facility. LPA reveiwed service records concerning (R-1) along with the current staff/resident roster and other documents in association with the allegations. Evaluation Report continues on LIC9099-C Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Resident was left on the ground for an extended period after falling. It is alleged the staff neglected (R-1) for an extended period after a fall. The complainant claims (R-1) was left for an extended period of approximately 1-3 hours on 07/08/21 in her room located on the second floor. An interview with (R-1) claims she had fallen while transferring from bed to her wheelchair. Later, she stated she fell in the bathroom. (R-1) reported the incident happened approximately at 11 am. Then again claimed it happened early morning when it was still dark. (R-1) states she received assistance from staff within 30 minutes. Afterwards, (R-1) stated there was no assistance from staff and she managed to crawl to the first floor on hands and knees for help. An interview with staff #1-#4 (S1-S4) all dispute (R-1)'s claim on how the incident occurred. Staff #2 (S-2) reports that she was the first staff on the scene to discovered (R-1) laying on the ground by her bed and not in the bathroom. (S2- S4) all reported the incident happened around 6:30 am and not during mid-day as (R-1) first claimed. (S1-S4) all had consistent accounts of the incident. Moreover, (R1) received immediate assistance with 911 dispatched. (R-1) was taken for medical evaluation. (S1-S4) claim the proper emergency procedures were applied and that Community Care Licensing and Ombudsman were notified. Interviews with residents (R2-R10) second floor residents, all claim that staff are attentive to their care and have not encountered any type of neglect. (R2-R10) included in their statements that they did not hear (R-1) call out for help during early morning hours on 07/08/21. A particular statement from (R-3) claims he conducts his daily morning walking exercises in the hallways of the second floor would have overheard (R-1) call for assistance. Based on information gathered and service records reviewed, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Resident care needs are not being met. It is alleged the staff is not meeting (R-1)'s care needs. The complainant reported (R-1) appeared unkempt and unpleasant smell when she was admitted to the hospital on 07/08/21. An interview with (R-1) disputes this claim. (R-1) states that her appearance was satisfactory and that she is happy with the care that is provided by the staff. (R-1) claims as a resident at this facility, she has no problems here. Interviews with (S1-S4) all dispute this allegation and states that (R-1) has never seen unkempt or presented herself with an unpleasant smell. (S-1) claims that (R-1) is independent, however, needs assistance with bathing. (S-1) states there may be some occasions that (R-1) may choose not to bathe and that a sponge bath is available Evaluation Report continues on LIC 9099-C as an option when (R-1) refuses to shower. This technique is used by the staff to maintain comfort and dignity for (R-1). A review of the "shower notes" log verified that services were performed weekly. Interviews conducted with residents #1-#10 (R1-R10) all indicate they are completely satisfied with the care and services provided by the staff at this facility and have not felt negelected. During the interview, the Department observed (R-1) appeared presentable in appearance and did not exude any malodorous odor. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R-1)'s service records, incident report, and interviews conducted and found no evidence to support the allegations: "Resident was left on the ground for an extended period after falling", "Resident care needs are not being met". Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Ginger Enriquez and a copy of the report was provided by email.the state’s words, verbatim · CDSS document, Jul 13, 2021 · control 11-AS-20210709130912