Tuscan Blue II

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Allegation investigated: Staff failed to provide necessary hydration, nutrition and basic care Administrator and staff failed to monitor and supervise the resident Staff failed to ensure the resident received necessary medical supplies and monitoring

On 01/23/26 5PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent complaint visit, met with staff (S1) and spoke to administrator (ADM) on the phone who authorized S1 to act on her behalf and sign the reports. LPA delivered investigation findings to ADM and S1. LPA explained the purpose of the visit with staff. During investigation, LPA obtained the following documents from administrator – Personnel record (LIC500), Resident roster, pre-appraisal reports, Admission agreements, physician's reports, Needs/Services plans, ID/Emergency information, Hospice care plans, Medication administration records (MARs starting July 2025 to December 2025), special diet records, Care Progress notes, incident reports. Continued on next page, LIC9099-C Unsubstantiated Allegation: Staff failed to provide necessary hydration, nutrition and basic care Investigation Finding: Unsubstantiated During investigation, LPA interviewed reporting party (RP), staff (ADM, S1) and reviewed R1’s documents. Resident (R1) had a fall from her home and was first admitted at the facility on 07/19/25. During her stay at the facility, R1 was evaluated by her primary care physician who recommended hospice services be provided since R1 would not eat because she did not like the taste of medications given. R1 was admitted into hospice care on 08/26/25. Staff (ADM, S1) stated they followed the hospice care plan for R1 which was to provide a special diet (R1 has Type 2 diabetes), hydrate and continue to administer medications, document refusal of medications and work with hospice care team in assisting R1 improve her condition. On 11/21/25, hospice care team determined R1's health has improved to the point that hospice care is no longer required. Review of R1’s hospice discharge summary report dated 11/22/25 showed R1 had improved mid-arm circumference. Hospice discharge report also showed R1’s initial intake of meals were 30%, upon discharge her daily consumption of meals were 25 to 75%, eating 3 meals a day. occasionally eating 100%. Her independent functioning has improved from 1: 1 feeding on admission to being able to feed herself on discharge and that R1 had a stage 2 pressure injury on admission but was healed at the time of discharge. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that staff failed to provide necessary hydration, nutrition and basic care to R1 is unsubstantiated. Continued on next page, LIC9099-C pg2 Allegation: Administrator and staff failed to monitor and supervise the resident Investigation Finding: Unsubstantiated During investigation, LPA interviewed reporting party (RP), staff (ADM, S1) and reviewed R1’s documents. Review of R1’s physician’s and appraisal reports dated 07/19/25 and 09/08/25 showed R1 health history as acute failure to thrive, protein calorie malnutrition and dementia. On 08/26/25, R1 was admitted into hospice care. On 11/21/25, the hospice care team determined R1’s health improved and released her from hospice care. However, due to R1’s continued refusal to eat because she did not like the taste of medications given, ADM stated both R1’s authorized representative (DPOA) and primary care physician (PCP) decided to put her back into hospice care on 12/30/25 due to her declining health condition. Staff (ADM, S1) stated they continue to monitor/ supervise R1 and follow the hospice care plan for R1 which was to provide special diet (R1 has Type 2 diabetes), hydrate and continue to administer medications, document refusal of medications and work with hospice care team in assisting R1 improve her condition. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that staff failed to monitor and supervise the resident is unsubstantiated. Allegation: Staff failed to ensure the resident received necessary medical supplies and monitoring Investigation Finding: Unsubstantiated During investigation, LPA interviewed reporting party (RP), staff (ADM, S1) and reviewed R1’s documents. On 12/03/25. LPA observed R1 to be clean, well groomed, odor free and comfortable with staff assisting with her activities of daily living (ADLs – incontinent care, meals, medication administration, grooming, dressing, bathing, toileting). LPA toured the facility and observed R1 had an approved medical bed, a wheelchair, side table and sufficient supply of diapers and medications as prescribed by her primary care physician (PCP). Staff (ADM, S1) stated they followed R1’s hospice care plan and continue to administer medications, document refusal of medications and work with hospice care team in assisting R1 improve her health condition. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation that staff failed to ensure the resident received necessary medical supplies and monitoring is unsubstantiated. Exit interview conducted and a copy of this report provided. Allegation: The facility misrepresented itself as a hospice provider Investigation Finding: Unfounded During investigation LPA interviewed reporting party (RP), staff (ADM, S1) and reviewed R1’s documents. Review of the State License issued on 10/04/2019 to the facility as a Residential Care Home for the Elderly (RCFE) showed the facility has an approved hospice waiver for three (3) residents. The facility is permitted to accept or retain residents who have been diagnosed as terminally ill by his or her primary care physician to reside in the facility and receive hospice services from a hospice agency in the facility. This Department has investigated the allegation that the facility misrepresented itself as a hospice provider and found the allegation without a reasonable basis and is therefore unfounded. No deficiency cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 23, 2026 · control 15-AS-20251203084650

Type of visit: Required - 1 Year

On 09/17/25 at 1PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct a required annual inspection. LPAs met with staff (ADM) and explained the purpose of the visit. LPAs observed ADM has a current RCFE administrator certificate# 7017765740 which expires 01/16/27. At 1:10PM, LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizer were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 72 deg F. Hot water temperature was measured at 108 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. Fire extinguisher was observed fully charged. LPA reviewed 5 staff and 5 resident files. Updated copies of the following documents were collected at the facility:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 17, 2025

Type of visit: Required - 1 Year

On 08/29/24 at 1:43PM, Licensing Program Analysts (LPAs) D Panlilio and D Doidge arrived unannounced to conduct a required annual inspection. LPAs met with staff (ADM) and explained the purpose of the visit. LPAs observed ADM has a current RCFE administrator certificate#6050378740 which expires 01/16/25. At 2PM, LPAs toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizer were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 74 deg F. Hot water temperature was measured at 106 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. Fire extinguisher was observed fully charged. LPA reviewed 3 staff and 4 resident files. Updated copies of the following documents were collected at the facility:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 29, 2024