complaint·July 11, 2023

On or about 5/30/23, a meeting was held between R1, R1’s Power of attorney (POA), Ombudsman and Atria’s Administrator. In the meeting, all parties agreed that for R1’s stability and as R1 plans to move from the facility soon, a compromise plan would be put in place where R1 would continue to have a room in memory care but be allowed to join activities, as they wished, in assisted living in order to associate with other residents. However, Atria staff were concerned about R1’s decision making and made R1’s movement within the community contingent upon staff availability. In interviews on 6/14/23 and 6/28/23 R1 and Atria staff reported that R1 at times would refuse the offers to join assisted living activities and when R1 changed their mind, staff were not always available to escort R1 immediately. On 6/27/23, R1 was offered an assisted living activity and declined. Shortly thereafter, R1 stated they wished to go to the activity. R1 then insisted and was denied until staff were available. R1 then chose to exit memory care through a side gate and was attended to by staff who escorted R1 back to memory care. R1’s POA forwarded a copy of the updated LIC 602 on 6/9/23. In interview with the Director on 6/14/23, the director expressed concerns with the change in diagnosis and some behaviors on the part of R1. The facility staff had not reached out to the physician who authored the report to voice concerns and observations of R1. While LPA acknowledged the concerns of the Director, LPA again emphasized that those concerns and need for supervision also apply to some residents in assisted living, who have cognitive deficits, who are not one-to-one, nor have their movements or associations with others restricted to a memory care placement. Staffing and communications appropriate to R1’s needs were discussed. R1 has since moved from the facility to live with family. As a result of this investigation, LPA finds allegation to be (S) 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 deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Report reviewed with Christina Ortiz. Copy of this report and appeal rights provided.