complaint·April 19, 2022

Regarding allegation " Staff did not respond to resident's call button in a timely manner": LPA Colvin interviewed facility staff and reviewed facility call button response times. The response time log shows three pendant call for 3/8/22 (7:42pm, 7:46pm, & 7:55pm). The first two calls show response times in 3 minutes and 5 minutes, while the third pendant call shows response in 17 minutes. In reviewing the call log with the Assistant Executive Director and Care Service Director, it was unclear who responded to the first two calls, and all persons interviewed by LPA Colvin deny any staff attending to previous calls before the last call at 7:55pm (or knowledge of these calls occurring). The facility maintains a log for the staff pendants in order to identify who responded to each call, however, the pendant that was used on the first two calls had not been signed out for since 3/2/22. All interviews of parties involved maintain that no staff attended to R1 prior to the response to the 7:55pm call, wherein emergency services were called for R1 due to the fall and R1 hitting their head. Since there is conflicting information on when R1 first called for help after the fall and when staff responded, the allegation of "Staff did not respond to resident's call button in a timely manner" is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Assistant Executive Director Monique Moreira and a copy of the report was provided.