Lakepoint El Dorado, LLC

In the surveyor’s words

From the most serious findings on record at Lakepoint El Dorado, LLC, in the surveyor’s own words.

• Immediate jeopardy, isolatedF600Jul 24, 2024

  The facility reported a census of 52 residents, with three residents sampled for abuse. Based on observation, record review, and interview, the facility failed to prevent the sexual abuse of cognitively impaired Resident (R) 3, who lacked the ability to consent. On 07/09/24 at approximately 03:30 PM to 04:00 PM, Certified Nurse Aide (CNA) N observed cognitively intact R2, who had a history of touching R3, with his hand inside R3's pant leg to her groin area. R3 had severe cognitive impairment and inability to consent, placing her in immediate jeopardy, based on a reasonable person concept, and at risk for trauma and a negative psychosocial impact. […]

• Immediate jeopardy, isolatedF610Jul 24, 2024

  The facility reported a census of 52 residents, with three residents sampled for abuse. Based on observation, record review, and interview, the facility failed to protect cognitively impaired Resident (R) 3, who lacked the ability to consent, from sexual abuse. On 07/09/24 at approximately 03:30 PM to 04:00 PM, Certified Nurse Aide (CNA) N observed cognitively intact R2, who had a history of touching R3, with his hand inside R3's pant leg to her groin area. R3 had severe cognitive impairment and inability to consent, placing her in immediate jeopardy, based on a reasonable person concept, and at risk for trauma and a negative psychosocial impact. […]

• Actual harm, isolatedF686Aug 17, 2021

  The facility reported a census of 51 residents with 16 selected for review, which included four residents reviewed for pressure ulcers. Based on observation, interview, and record review, the facility failed to ensure appropriate pressure relieving interventions were in place for one resident (R)13, who had a worsening pressure ulcer on her lateral (side) shin area. In addition, the facility failed to provide sanitary pressure ulcer dressing changes for three residents, R13, R49 and R3, also reviewed for pressure ulcers. […]

• No harm, potential for more than minimal, widespreadF725Jan 26, 2022

  The facility reported a census of 46 residents. Based on Interview and record review the facility failed to provide adequate sufficient nursing staff to provide nursing related services of adequate bathing/hygiene, to maintain the highest practicable physical, mental, and psychosocial well-being for at least 19 residents, including; (R2, R3, R4, R5, R6, R7, R9, R10, R11, R 2, R 3, R14, R15, R16, R17, R18, R19, R20, R21, and R22). Findings Included: - On 01/25/22 at 08:34 AM, resident (R)5, stated the facility needed more staff. She was not getting a shower every other day like she preferred. She reported she was lucky to get one bath a week. R5 reported she was dependent on staff to raise her legs and she had told staff she wanted to be bathed more frequently but nothing changed. […]

• No harm, potential for more than minimal, patternF623Dec 18, 2024

  The facility had a census of 55 residents. The sample included 15 residents of which seven were reviewed for hospital discharge. Based on observation, record review, and interview, the facility failed to notify the resident and/or the resident's representative in writing of the reason for the facility-initiated discharge. Further, it failed to send a copy of the notice to the State Long Term Ombudsman (LTCO) for Resident (R) 28, R33, R11, R18, R22, and R41. This placed the residents at risk for uninformed care choices and impaired rights. […]