complaint·December 3, 2021

toured the facility with Administrator at 11:33 AM, and reviewed pertinent resident file information. During the course of the investigation, LPA reviewed R1’s medical record and facility file information. The following was then determined: Interviews and record review revealed R1 schedules all their own medical appointments, arranges their own transportation, and is responsible for communicating with their own physician. Licensee interview revealed R1 has copies of their medical documentation and does not release information to the facility regularly. LPA requested copies of doctor’s orders during initial visit as well as both subsequent visits. Both R1 and Licensee were unable to provide copies of physician’s orders. LPA reviewed R1’s medical records obtained by CCL during the course of the investigation; review did not reveal orders for stretching which were referred to in the complaint. There was a statement by a nurse indicating “doctor ordered physical therapy” on 05/20/2019. No copy of the doctor's orders were contained in R1's medical record and no further information was provided. Based on interview and record review, although the allegation may be vaild, at this time there is insufficient evidence to prove the allegation occurred, therefore the allegation that “staff did not follow physician's orders” is deemed UNSUBSTANTIATED at this time. Exit interview was conducted with Justin Levi. Report was provided via email.