complaint·May 17, 2022

Allegation is that facility is short staffed (one staff per building) and residents' needs are not being met in a timely manner. Specifically, staff are not able to assist residents with showering as often as needed. Three Med-Techs were interviewed on 2/24/22. One Med-Tech stated that staffing has been okay so far and there are 2 outside agencies providing staff- 2 staff are placed in Building B and in Building C and 1 staff is placed in Building A. The same Med-Tech stated that from 4-6 pm, staff are the busiest, and there are 2 caregivers that work 12 hours and 1 "floater" caregiver that works in building B and C but can go to building A if needed. A second Med-Tech stated the facility uses agencies if needed so there are 3 Med-Techs on each shift, one for each building, A, B and C. This Med-Tech stated that she will assist with showers, if needed, and the average time is 5-10 minutes, residents don't usually have to wait long and the mornings are the busiest. This Med-Tech stated that sometimes staff doesn't clear the pendant button so the response time can appear longer than it actually is and sometimes residents can refuse a shower. A third Med-Tech stated that the facility is using agencies currently with Covid cases and the staff from agencies "don't respond to radios and don't communicate well" and many work 12 hour shifts. This Med-Tech stated staff has communicated to management that additional caregivers are needed from 6 am- 9 am and from 4 pm- 7 pm but 1 Med-Tech is always sufficient at any time. Three residents were interviewed on 2/24/22. One resident confirmed he does not use the pendant to request assistance and staff will attend to him in 5 minutes or less. A second resident stated she receives standby shower assistance and there are no issues with using the call pendant. A third resident indicated she receives a shower twice/weekly and there is a helper that helps her- and showers are given as scheduled and are "always on the right day". The same resident stated she has never had a pendant and always receives assistance when it's needed. LPA reviewed shower schedules, printed on 3/3/22, for Assisted Living residents. Schedule showers are scheduled from once weekly to daily and notes are added as to the amount of assistance resident needs. Based on information obtained through interviews and documentation reviewed, LPA finds the above allegation to be UNSUBSTANTIATED- meaning 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. cont on 9099C(2)... 9099C(2).. Allegation: Staff are not assisting residents with ambulating to the restroom in a timely manner. Allegation is that staff are not able to assist residents with walking to the restroom in a timely manner, which has resulted in residents having poor hygiene and having "accidents" that could have been avoided or having to "hold it' while waiting for staff to assist. One resident said she does not need any assistance with toileting, and there are no issues with using the call pendant. A second resident said he does not use the pendant to request assistance and staff will attend to him in 5 minutes or less. A third resident said she has never had a pendant. One Med-Tech stated that average time is 5-10 minutes, residents don't usually have to wait long, the mornings are the busiest, and sometimes staff doesn't clear the pendant button. A second Med-Tech stated "Sometimes it's a problem- we help as needed and work as caregivers if someone needs shower help. On Hall A, there is 1 male caregiver and sometimes there is a delay if a female resident needs a shower and prefers a female caregiver . On Hall B, 1 -2 caregivers is usually okay since the residents are more independent. "Hall B and C are the busiest and there are a lot of pendant pushes for escorts, toileting and showers". The pendant calls go to staff's pagers. Residents are asking for more help on Hall B and C. The same Med-Tech stated that staff has communicated to management that from 6 am- 9 am and from 4 pm- 7 pm and during this time, 3 caregivers are needed. This Med-Tech stated the biggest concern is "the Med-Tech is supposed to be on the floor at the same time they are passing meds- Maybe we need another floater or more staff from the outside agency". LPA reviewed pendant reporting for period 12/21/21 - 1/31/22. SED stated "Our average (mean) response time for the attached pendant reporting period is 13.1 minutes; the median response time is 10.67 minutes. Our policy goal is a 15-minute response time, so we are compliant with our policy". LPA observed several repose times to be significantly longer than 15 minutes. SED provided several reasons why a response time may be greater than 15 minutes, as follows: " The log records a “response” when the pendant is cleared—not when a staff member arrives...Staff do not clear the pendant until the resident’s needs have been met.... Also, staff sometimes forget to clear the pendant immediately after providing service to the resident. Finally, in some instances, residents simply refuse to allow us to clear the pendant or there is a malfunction with a pendant that will not allow us to clear it." cont on 9099C(3).. 9099C(3).. SED provided an update during the investigation, on 3/7/22, stating the facility has dedicated many resources over the past few months to improving pendant response times- "The most significant issue was residents using the pendants as a “concierge” button—in other words, non-emergencies. We have re-educated residents on the proper use of the pendant and greatly reduced the number of pendant calls. In addition, the vast majority of pendant calls were coming from a very small number of residents, some of whom would press their pendants 10-20 times per day. These residents were evaluated on their ability to understand the proper use of the pendant and, if appropriate, moved to a higher level of care (e.g., memory care). While we had made significant improvement in response times in December and January, I am pleased to report that the average response time for February was 8.99 minutes, and the average response times for the past seven days has dropped below five minutes." SED provided LPA with pendant response documentation times for April 2022 and May 2022. For April 2022, the average response time is 3.43 minutes and for May, the call average is 1.51 minutes for May 2022. Based on information obtained through interviews and documentation reviewed, LPA finds the above allegation to be UNSUBSTANTIATED- meaning 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. Exit interview. Copy of report provided to Executive Director.