complaint·April 3, 2024

Continued from LIC9099 Facility documents indicated that R1 had single room accommodation starting 10/26/2022 but did not pay at the single room rate until January 2023, creating a balance of $10,859.50. Financial statements indicated that the daily rate for March 2023 was $355 per day. Interview with Administrator and review of financial statements indicated that R1 was billed until March 23, 2023 leaving 8 days of occupancy left. This was credited in the amount of $2,849.29 which was applied to R1’s outstanding balance from November and December 2022, therefore, a refund was not issued as there was no refund due. Review of R1’s Medical Contract Version 5 dated 05/25/2016, under Part V. Covered Services and Covered Supplies stated “…SNF and PCU Care shall be in a semi-private room…” and Part VI. Exclusions stated, “The following are excluded from the Residents coverage under this contract. Their costs shall be borne by the Resident to the extent not covered by Medicare, private insurance, or other resources…surcharges for a private room are excluded…” Based on documents reviewed, interviews conducted, and observations made, this allegation is UNFOUNDED . A finding that the Complaint is Unfounded means that the allegation was false, could not have happened and/or is without a reasonable basis. No Deficiencies cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.