complaint·February 13, 2024

The investigation revealed the following: Regarding the allegation "staff did not follow COVID protocol”, it is alleged that staff failed to follow COVID-19 guidelines. Staff interviewed denied the allegation and stated that full PPE supplies were used when there was a COVID-19 positive case. Residents interviewed could not corroborate the allegation. Regarding the allegation "staff did not aid residents with incontinence needs”, it is alleged that staff were not changing the diaper for R1, R4, and R5. Staff interviewed denied the allegation. They stated all residents that need diaper change receive incontinence assistance every 2 hours or as needed. Even if the resident has COVID-19 the staff are expected to wear full PPE supplies and provide the incontinence assistance. Residents interviewed could not corroborate the allegation. Regarding the allegation "staff did not observe change in residents condition”, it is alleged that staff did not check on R1 for 6-7 hours. Staff interviewed denied the allegation. They stated that R1 was severely ill and was placed on "alert charting" which meant that staff had to check on R1 every hour and complete a chart behind the resident's bedroom door. Residents interviewed could not corroborate the allegation. Regarding the allegation "staff did not feed bedridden residents”, it is alleged that staff did not feed R1 and R2 because R1 had COVID-19 and staff did not want to get near R1 and R2 would eat slow so the staff would get impatient. Staff interviewed denied the allegation. They stated that all residents are provided food and assisted with eating if the resident needs assistance. If a resident has COVID-19 then the staff are expected to wear full PPE supplies and assist the residents with feeding. Residents interviewed could not corroborate the allegation. Regarding the allegation "staff did not aid residents with hygiene needs”, it is alleged that staff did not shower R4. Staff interviewed denied the allegation. They stated all residents receive shower assistance up to 2-3 times a week or as needed. LPA reviewed the shower schedule and observed all residents name listed 2-3 times throughout the week. Residents interviewed could not corroborate the allegation. 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. Exit interview held and a copy of the report was provided