complaint·July 20, 2021

Allegation #2 – Staff neglect resulted in injuries to residents. Licensee stated on 8/29/2020, R1 slid out of the wheelchair and onto the floor, resulting in a leg laceration. On 2/9/2021, R1 fell a second time when the resident fell out of the wheelchair again, while attempting to turn on the television. R1 sustained a head laceration. In both incidents the Licensee called 911 and R1 was transported to the hospital for treatment. Licensee was interviewed and denied the injuries were sustained as a result of neglect. Per the Licensee R1 will forget and attempt to get up without staff assistance. Therefore, the information obtained could not corroborate the allegation that R1 sustained injuries due to staff neglect. Allegation # 3 - Residents are locked in their rooms. Information provided was that Licensee will lock resident’s bedroom doors and that the Licensee has moved a couch in front of R1’s bedroom door to prevent R1 from exiting the room at night. Licensee denied barricading R1 in the bedroom or locking resident’s doors. LPA inspected the resident’s bedroom doors and did not observe any locks on the doors which would allow the Licensee to lock resident’s in their rooms. Due to a lack of additional information the allegation could not be corroborated. Allegation #4 - Staff over medicate residents in care. Information was reported was that Licensee sedates R1 at night so that resident will sleep through the night. Licensee denied sedating R1 at night. Licensee stated R1 is only given medication as prescribed by the doctor. LPA reviewed R1’s Medication Administer Record which indicated R1 is given medication as prescribed. Allegation #5 - Residents medications are not locked. LPA inspected the cabinet where resident’s medications are stored and observed it to be locked at the time of inspection. Licensee denied leaving the cabinet unlocked and medications accessible to residents. Additional witness interview provided information that the medication has been observed locked in the cabinet. Allegation #6 - Staff yell at residents. Licensee stated some of the residents are hard of hearing and at times she must talk loudly to be heard, but she denied the allegation that she yells at them. Interviews with additional witness’ could not corroborate the allegation that residents are yelled at by the Licensee. Allegation #7 - Staff are not trained. Information reported was that Licensee, is the sole caregiver and has left residents in the care of untrained individuals while leaving to go on vacation. Licensee denied the allegation, stating she has not gone on vacation nor has she brought in untrained caregivers. Licensee stated she has not left the house in months. She states her mother assist her with going grocery shopping and running errands so the Licensee can care for the residents. Based on the information obtained there is not enough evidence to state staff did not meet the needs of the resident, resulting in dehydration, staff neglect resulted in injuries to residents, residents are locked in their rooms, staff over medicate residents in care, residents medications are not locked, staff yell at residents or that staff are not trained. 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 at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Tyla Kincherlow, Licensee.