Complaint·July 16, 2021

Based on the IB investigators investigation, the investigation revealed the following: For Allegation 1 –Resident suffered from malnutrition while in care. Resident suffered from dehydration while in care. IB investigator interview’s with Wellness Director, stated that R#1 nutrition was a concern. R#1 always refused her food, R#1 was on a liquid diet and sometimes refused the liquid food(Boost) stating she was fine and that’s how R#1 looked. Interviews with care givers, also stated that R#1 refused to eat and always stated R#1 was fine and not hungry to leave R#1 alone. R#1 records revealed a significant health history to mild protein caloric intake malnutrition. Loss of appetite, abnormal weight loss, and anorexia which may have been contributing factors in the alleged. IB investigators review of R#1 medical records, also read that R#1 had a well documented on-going concern with R#1 malnutrition (diet) and Dehydration. The interviews conducted and records reviewed by IB Investigator Patterson did not concur with the above allegation. Allegation #2 - Resident suffered from dehydration while in care. IB investigator interview’s with Wellness Director, stated that R#1 nutrition was a concern. R#1 always refused her food, R#1 was on a liquid diet and sometimes refused the liquid food, stating she was fine and that’s how R#1 looked. Interviews with care givers, also stated that R#1 refused to eat and always stated R#1 was fine and not hungry to leave R#1 alone. R#1 records revealed a significant health history to mild protein caloric intake malnutrition. Loss of appetite, abnormal weight loss, and anorexia which may have been contributing factors in the alleged. IB investigators review of R#1 medical records, also read that R#1 had a well documented on-going concern with R#1 malnutrition (die) and Dehydration. The interviews conducted and records reviewed with the above allegation. Allegation #3 - Resident sustained serious injury while in care resulting in hospitalization. IB Investigator interviewed Wellness Director and Care givers, stated that when R#1 was checked on, and visually observed and spoken to R#1 within the approximate hour of R#1 un-witnessed fall, while being at R#1 normal baseline. 911 was called and R#1 transported to hospital. R#1 CT head scan revealed a very small parenchymal hemorrhagic contusion of the left frontal lobe. Ct brain showed stable bleed. R#1 was discharged in stable condition. The interviews conducted and records reviewed by IB Investigator Patterson did not concur with the above allegation. Allegation #4 - Resident was left unsupervised for extended period of time after falling. IB Investigator interviewed Wellness Director and Care givers, stated that when R#1 was checked on, and visually observed and spoken to R#1 within the approximate hour of R#1 un-witnessed fall, while being at R#1 normal baseline. R#1 was checked on during the night by nocturnal staff and was found to be asleep. Medical technician also checked on R#1 that early morning before breakfast. The morning staff (care giver) began their rounds and checked on R#1 around 08:00am and R#1 was laying down on her bed and advised care giver she did not want breakfast. The fall must of occurred sometime after her visit (few minutes later,) because they informed her of R#1 fall. The interviews conducted and records reviewed by IB Investigator Patterson did not concur with the above allegation. Allegation #5 - Facility failed to seek resident timely medical attention. IB Investigator interviewed Wellness Director and Care givers, stated that when R#1 was checked on, and visually observed and spoken to R#1 within the approximate hour of R#1 un-witnessed fall, while being at R#1 normal baseline. They continued to state that 911 was called immediately. The medical records obtained from hospital, support R#1 arrival to the ER approximately 10:14 hours, due to a fall complaint and the hospital flow sheets reported no signs or suspicion of abuse or neglect and the facility did not fail to seek untimely medical attention. The interviews conducted and records reviewed by IB Investigator Patterson did not concur with the above allegation. Although the allegations may have happened or is 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 Marylou Jeynty, Business Office Manager and a hard copy was provided.