complaint·May 6, 2021

The increased cost associated with the new care plan and services being provided with R1 was not discussed with R1’s Durable Power of Attorney (DPOA). CCL learned the DPOA was informed of the changes to R1’s care plan on a telephone call, but did not discuss the change in monthly rate. CCLD determined through documents reviewed and interviews conducted; the increase in Personal Service Rate was not discussed with the DPOA. Based on the interview and records review, CCL finds the above allegation to be SUBSTANTIATED – A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiency is being cited on 9099-D, per Tittle 22 regulations: 87507(f) – Admission Agreements. Exit interview conducted. Copy of report sent to the facility via e-mail, Administrator to sign and return a copy to CCL either by fax or email, a copy should be retained for facility records as well. Appeal rights provided. Based on records reviewed, R1’s Personal Service Plan was received by DPOA on 5/16/2020, the invoice generated for services provided was created on 5/14/2020. CCL learned the new care plan sent to DPOA was returned to the facility with notes and redacted sections the same day indicating DPOA did not agree with the changes made to the care plan. CCL learned DPOA made multiple attempts to reach out to facility to discuss, but was unsuccessful until 5/24/2020, while unapproved care plan was being implemented. As the regulation states “failure to respond to written requests by a family council in a timely manner .”, the use of “timely manner” is found to be ambiguous. Based on interviews conducted it was discovered that facility performed the reappraisal procedure correctly. The facility involved the POA and reviewed the reappraisal over the phone. The facility went over change of condition, did a Montreal Cognitive Assessment (MOCA), and contacted physician with the new care plan and reappraisal. Based on the facts provided, LPA finds the above allegations to be to be UNFOUNDED – a finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. Copy of report sent to the facility via e-mail, Administrator to sign and return a copy to CCL either by fax or email, a copy should be retained for facility records as well.