complaint·June 11, 2024

To investigate the allegation at 10:38a, LPA interviewed resident (R1) at 11:00am, LPA spoke with the facility staff and at (time) LPA discussed the allegation with the Administrator over the phone. LPA DeLACerra observed and assessed R1 during interview. R1 is an amputee (Left foot amputated) and is in hospice care. R1 was already using hospital bed. L PA observed that the bed for R1 was in good repair. R1 revealed that they are residing in the facility since May 21, 2024. R1 was placed in bedroom #2 with a hospital bed. Resident verified that currently they are receiving hospice services. On 05/22/2024, R1 was given a suggestion by the hospice worker to request a new hospital bed with bedrails. Within the same day, R1 followed the suggestion, and requested from a facility staff #2 (S2) who is administrator’s designee, a new hospital bed with bed rails. R1 verified that they had no prescription for a new hospital bed or bed rails issued for him by a physician. R1 also stated that the bed rails would help him for mobility due to being an amputee. The staff indicated that R1’s request was revealed to the hospice agency. Since R1 already had hospital bed, they ordered half bed rail for R1’s mobility. During the course of investigation while interviewing R1, a delivery person came from AAA Healthcare Products, Inc. and delivered the half bed rails for R1 in R1’s room. Staff revealed that R1’s request was discussed with the hospice agency. Bed rails were ordered on 06/07/2024 and delivered today on 06/11/2024. LPA visibly witnessed the delivery of the bed rails. Based on observation, interview and record reviews, there was not enough supporting information to confirm the allegation. Therefore, the allegation deemed unsubstantiated at this time. During this investigation, LPA noted other Title 22 Deficiencies. Therefore, Case Management visit was conducted to address other deficiencies unrelated to the complaint. Exit interview was conducted. Copy of report was signed by the facility staff. Due to the Administrator not being present at the facility, the copy of report will be delivered to the Administrator via e-mail.