complaint·August 24, 2023

Page 2 Allegation: Resident (R1) was not ambulated by staff as required. LPA interviewed 5 staff. One (1) out of 5 staff stated that R1's physical therapist wanted R1 to be walked but sometimes R1 refused. Four of the 5 staff stated they assist residents in walking, however, there are times when residents refuse. One the 5 staff stated she never walk resident if resident came from rehab or Skilled Nursing Facility and resident has broken bones. LPA interviewed R1's personal caregiver who stated she never observed staff walked R1. The personal caregiver of other resident was also interviewed who stated that when she needs help in assisting the resident she's hired for, the caregiver assists. Three out of 4 residents interviewed stated they can walk on their own. LPA was not able to get information from R1. Based on information gathered and LPA unable to obtain information from R1, the allegation of R1 was not ambulated by staff as required is closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. .......continued on 9099C (page 3) Page 3 Allegation: Facility failed to meet resident’s care needs. It was alleged that resident (R1) was not kept clean and left in wet, soiled diapers. The reporting party further stated that R1 was observed in soiled clothing and left in wet diapers on multiple occasions. LPA interviewed 5 staff, 4 residents, two personal caregivers and R1's family member on 10/06/21 and 8/24/23. One (1) out of 5 staff stated there were times she comes to the facility and observed residents in soiled clothing and wet diapers. One of the personal caregivers stated she observed R1 twice in soiled clothing and wet diaper, while the other personal caregiver stated she never observed the resident she's assisting and other residents in soiled clothing or wet. Four of the residents interviewed stated its either they don't need assistance in changing clothes and diaper while 1 stated the personal caregiver assist. The 3 residents stated they never observed other residents soiled and/or wet. R1's family member stated she never observed R1 in soiled clothing or wet diaper. During one of the visits, although LPA was not able to obtain information from R1, LPA observed R1 with no smell of urine and R1's clothing clean. Based on information gathered and LPA unable to obtain information from R1, the allegation of facility failed to meet resident’s care needs is closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit interview conducted, and copy of this report provided.