complaint·May 9, 2024

Allegations: Staff did not provide medical records as requested by resident. It was alleged that R1's medical records have been erased between 9/1/22 through 11/1/22. No records of hospitalization, medical procedure, nursing facility stay or any medication for that time period can be found. Interviewed staff denied the allegation. They stated that they always provide the medical records to the residents or Representative parties / conservator upon their request. S1 stated that information will be provided to resident /conservator immediately by their request. S2 stated that they provide medical records requested by residents for any hospital discharge, doctor's visits at all times without questions. They did not deny the access to medical records to any of the residents. S1 and S2 stated that it is residents right to be aware of any changes, any new diagnosis, or treatments that they might have. They stated that they provided R1's medical records that they have in the facility files. LPA obtained and reviewed the copy of R1's medical records and SIRs dated 09/01/22, 09/06/22, 09/07/22 and 09/10/22 and observed that R1 was hospitalized on 09/01/22 and left the hospital AMA (against medical advice) on 09/06/22. At the same day R1 was seen by the Facility doctor for an assessment after R1 left the hospital AMA. Home Health was requested because of R1's health condition. (Copies of Referral and doctor's order provided to LPA). On 09/07/22 R1 was transitioned to West Haven Nursing Home, and R1 left the Nursing Home again AMA. With no discharge papers, no plan, no indication. At the time of visit S1 provided copies of the R1's medical records and handle it to R1. Residents interviewed revealed that 10 out of 11 residents could not corroborate with the allegation. Allegation: Staff changed resident's medical insurance without the resident's consent. It was alleged that R1 Blue Shield insurance was cancelled on 8/31/22 without R1's permission to Medical.Net by a doctor at the facility, and R1's account was restricted to R1. Interviewed staff denied the allegation. They stated that Facility staff / doctors do not change insurances without the resident's / conservator's consent. They follow the mandated protocols and rules that protect resident's rights. They stated that facility staff / doctors didn't change R1's medical insurance with or without R1's consent. At the time of visit S1 assisted R1 in contacting Medicare and Blue Shield health plan. R1 spoke to multiply representative for over one hour and representatives informed that R1's insurance plan could only be canceled or switched with R1's consent. Continue 9099C They also told R1 that sometimes insurance plans find them not eligible and that they will switch the plan and inform them of the change. S1 indicated that happened with R3 before and S1 was able to assist with correcting the change. Insurance representatives found no information on any party canceling R1 plan on R1's behalf and R1 was never without coverage during any period. LPA was present at the time of phone conversation, Unfortunately, R1 not want to believe what the representatives are telling R1 and insists that a doctor changed their insurance plan. Residents interviewed revealed that 10 out of 11 residents could not corroborate with the allegation. Based on the interviews conducted with staff, residents, review of client file and facility records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Assistant Administrator Dennise Torres and the copy of this report was . provided.