complaint·October 11, 2024

Interviews with facility staff, and record review reveal that at admission to the facility, R1 already has an impairment and diagnosis causing for them not to keep hydrated and drink enough water, resulting into the UTI and dehydration. Additional information received from these interviews and record review, also reveal that at admission, R1 already had a history of UTI and kidney stones. R1’s responsible person always had to push for R1 to drink fluids to stay hydrated. Despite the facility’s care plan in addressing R1’s inability to keep hydrated, R1 still showed resistance to drinking and keeping fluids down, due to their mental condition. On or around October 3, 2023, there is documentation of a fall, resulting in medical treatment for dehydration. R1 was discharged and returned to facility 10/05/23, with instructions to encourage frequent hydration. Regarding R1 never regaining the ability to ambulate, interviews made with facility staff and record review reveal that R1 was already non-ambulatory when admitted into the facility, requiring the use of a wheelchair at times. Moreover, R1 was admitted with their own wheelchair. Based on the information obtained, although there was record of a fall caused by possible dehydration, there wasn’t enough evidence to prove that neglect by facility staff caused for R1 to become dehydrated. Therefore, the allegation is deemed Unsubstantiated at this time. Facility staff did not follow admission agreement/ Facility staff did not properly notify resident's responsible person of rate changes. In regards to the allegation, it was reported that since hospice staff have taken over certain responsibilities, the licensee is finding new things to charge for, such as “hospice interface” and continuing to charge for showers on non-hospice days. Moreover, staff are not logging showers to prove showers are being provided to R1. Interviews with facility staff reveal that that on or around January 31, 2024, due to the progression of R1’s condition and diagnosis, their primary physician ordered hospice care. Hospice care plan was initiated for once a week, of which, assistance with showers is included. Although some services, such as incontinence services were dropped from service points on the facility’s care system, there was a hospice collaboration points added to the admission agreement. Hospice and home health collaboration is always explained to the resident, and their responsible person, prior to admission. Moreover, assistance with bathing, which R1 did require, was still in the admission agreement, scheduled for two times per week, which was already agreed upon. Facility did maintain a shower log, as proof assistance with showers were provided and as agreed. Copies of these logs were provided to the responsible person. Copies also obtained by LPA during the investigation. R1’s responsible person was explained of these charges and new charges for both the addition and subtraction for services. R1's responsible person acknowledged, agreed and signed the documentation for the charges. Staff stated that without the responsible persons agreement to the new services and their signatures, hospice service would not have started. Based on the information obtained, there was insufficient evidence to prove that staff did not follow R1’s admission agreement, or the licensee did not notify R1’s responsible person of rate changes. Therefore, the allegation is deemed Unsubstantiated at this time. Facility staff did not answer communications from resident's responsible person. In regards to the allegation, it was reported that R1’s responsible person has attempted to call and email the licensee, trying to get clarification on the facility charges received on a statement dated 2/23/24 for the hospice interface and additional showers, but no response by the licensee was made. These charges were back dated to about 02/01/24. Interviews with facility staff and record review (copies of email interaction) confirm that there was communication between the facility business office, and R1’s responsible person to discuss the order placed by R1’s physician to initiate hospice service, the hospice care plan, changes to R1’s care, and rate charges and subtractions to R1’s admission agreement for services to be provided by the facility. R1’s responsible person acknowledged these changes and services, and the initiation for the hospice care., which they agreed and signed on for these services to start. Without the responsible person’s agreement and signature, hospice services would not have initiated. Based on the information obtained, there was insufficient evidence to prove that staff did not communicate with R1’s responsible person regarding clarification on their hospice service. Therefore, the allegation is deemed Unsubstantiated at this time.