complaint·March 20, 2023

According to hospital records dated February 2, 2021, page 92 of Hospital History and Physical, the cause of R1’s altered mental status involved a number of factors. “The first was likely due to polypharmacy, however, it was also aggravated by the UTI and fecal impaction. It was unclear how much medication R1 actually had been getting from the board/care facility.” Records and interviews disclosed that R1 was getting prescriptions from two different Doctor’s. According to text messages provided between the responsible party and the Licensee, the responsible party was aware of the doctor’s and pharmacy used by the facility. Based upon interviews and a review of R1's records, these allegations are unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Parinaz Safari and a copy of this report was provided.