Complaint·October 4, 2024

Allegation(s): Staff did not prevent resident from causing harm to another resident. The investigation revealed the following: Regarding the allegation "Staff did not prevent resident from causing harm to another resident,” it is being alleged that on 02/10/24 8:00 AM and 09/05/24 8:00 AM, Resident #1 (R1) was scratched in the face by Resident #2 (R2). The Report of Suspected Elder Abuse (02/10/24) revealed that the police were contacted to file a report and both residents were advised to stay away from one another. The Unusual Incident Report (09/05/24) revealed that responsible parties were notified, R1 and R2 will be monitored for changes in condition, R1’s behavior would be monitored, and residents will be encouraged to keep their distances. Interview with the Administrator indicated that both residents have been encouraged to use different elevators to avoid being in the same hallway for breakfast. The Administrator also indicated that conversations have been had with both Power of Attorneys regarding the incidents and the facility rules. Four out of five residents indicated staff supervise the area near the dining room halls around breakfast. Four out of six residents indicated that they feel safe at the facility. Regarding the allegation “Staff did not prevent resident from causing harm to another resident,” based on record review and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. Allegation(s): Staff did not report incident. The investigation revealed the following: Regarding the allegation " Staff did not report incident,” it is being alleged that resident-on-resident (Resident #1 and Resident #2) incident was not reported to the Long-Term Care Ombudsman Program. Record review revealed that The Report of Suspected Elder Abuse (02/10/24) was reported to the Police Department, Community Care Licensing, and Ombudsmen. The Unusual Incident Report (09/05/24) was sent to Community Care Licensing and a police report was filed. Interview with the Administrator indicated that the Wellness Director left a voicemail on the general line at the Ombudsmen’s office. Administrator also indicated that the Licensed Vocation Nurse documented and sent the Elder Abuse form and the Wellness Director documented and sent the Unusual Incident Report. Continue to LIC9099-C. Regarding the allegation “Staff did not report incident,” based on record review and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegations. An exit interview was conducted and a copy of this report was provided to the Staff Kyra Olguin.