complaint·January 26, 2024

During the interviews, the team was able to visit four (4) random resident rooms and inspected/tested four bathroom sinks/faucets for the leaks. The team did not observe any faucets leaking. Interviews with five (5) out of six (6) residents revealed that they had no issues with the shower and or faucet leaks. However, in two (2) out of four (4) rooms, the team observed that the outlet wall plates were broken/missing. Administrator informed the team that the electrician was already contacted and the work will be completed today. Based on the inspection and observation, this allegation is Substantiated. Deficiency cited on LIC9099-D. Exit interview conducted. Appeal rights explained and copy of this report signed and delivered. Allegation: Staff does not provide PRN medication to residents in a timely manner It was alleged that staff does not provide PRN medications to residents in a timely manner. To investigate this allegation, the team conducted an interview with the Administrator and the MedTech and was informed that all PRN medications are provided to residents in a timely manner and the staff immediately initials the PRN log. In addition, interviews with four (4) out of six (6) residents revealed that they never had any problems taking their medications or waiting for their medications for a long period of time. Lastly, the team conducted an inspection of R1's prescribed and PRN medications and did not observe R1 being prescribed a PRN (Ativan) medication. Based on inspection, observation and interviews there is no sufficient evidence to support the allegation. Therefore, this allegation is Unsubstantiated at this time. Allegation: Staff refused to seek medical attention for resident. To investigate this allegation, the team conducted an interview with the Administrator and was informed that the facility staff always contacts 911 when an incident occurs with residents. Once the paramedics arrive and determine that it is not an emergency situation they may not take the resident to an Emergency Room (ER). In addition, the team was informed that the resident also has an option to refuse 911 services, upon paramedics arrival. Moreover, the team was informed that R1 calls 911 very frequently and most of the time the calls are done for a false emergency situation due to R1's medical and mental condition. Interview with two (2) staff members revealed that before their employment facility provided a training regarding the emergency situation and procedures. Both staff members also informed the team that each and every emergency situation is being handled, immediately. Interviews with four (4) residents revealed that the staff members are well trained and handle emergency situations on a professional level. Lastly, review of R1 Incident Reports confirmed that the facility always calls 911 when resident expresses behavior episodes and or upon residents' request. Based on inspection, observation and interviews there is no sufficient evidence to support the allegation. Therefore, this allegation is Unsubstantiated at this time. Allegation: Staff does not keep the facility clean and sanitary To investigate this allegation, the team visited five (5) resident random rooms and observed all rooms are clean and well taken care of. The team also conducted an interview with two (2) housekeepers and was informed Continue on LIC9099-C that the facility resident rooms and common areas are being cleaned every day. Lastly, the team conducted interviews with five (5) residents and none of the residents expressed any issues/concerns regarding this allegation. Based on observation and interviews there is no sufficient evidence to support the allegation. Therefore, this allegations is Unsubstantiated at this time Allegation: Staff does not safeguard resident's personal items. It is alleged that R1's personal item has gone missing. During today's walk through, the team observed that the missing item that was initially reported missing was actually present at R1's room. In addition, interview with the Administrator revealed that at times residents may misplace their personal items and once it brought up to the management's attention the facility staff will relocate and return the missing item. Moreover, the team conducted interviews with five (5) residents and four (4) out of five (5) residents did not express any concerns regarding this allegation. Based on observation and interviews there is no sufficient evidence to support the allegation. Therefore, this allegations is Unsubstantiated at this time. Allegation: Staff is disrespectful to resident. It was alleged that facility staff members yell at the residents during the dinner time if they don't hurry finishing their meals on time (by 6:00pm). Interviews with the Administrator, two (2) staff members revealed that at times staff members might raise their voice to those residents that are hard of hearing. When they speak to those residents that are hard of hearing the raising of their voice is not meant to be in anger/disrespect, it is just so that the resident understands what the staff members are talking about. Moreover, interviews with four (4) out of six (6) residents confirmed that they are being treated very well by the facility staff members and were never treated disrespectfully by the staff. Based on information obtained through interviews this allegation is deemed Unsubstantiated at this time. Exit interview conducted and copy of this report signed and delivered.