complaint·January 31, 2020

While R1 was place at facility staff reported no previous fall history in records. Furthermore, facility staff reported R1 to be required to wear C-collar on his neck; however, R1 would constantly take it off and misplace it. Based on the insufficient evidence, the allegation(s) of #1 Resident sustained a fractured neck while in care and #2 Facility staff failed to safeguard residents personal belongings is UNSUBSTANTIATED. No deficiencies given during todays visit. An exit interview was conducted with Administrator, Annamarie Santos were a copy of this report was discussed and provided LPA was informed that the need for coverage in the memory care unit is constant, as a result to supplement the coverage needed medical technicians are used for both covering caregiving gaps and dispensing medication for a total of 34 resident in care. Additionally, review of staff schedule for the month of September 2019 shows that in the memory unit morning shifts had 3 staff scheduled for coverage on Sundays, Mondays, Wednesdays, Thursdays, and Fridays, and 4 staff scheduled for Tuesdays and Saturdays; However, per documents provided the coverage provided on September 19, 2019 through September 30, 2019 shows inconsistencies with staffing schedules on 9 different dates. Dates identified in which staff schedule did not match coverage needed are, September 19th 3 staff scheduled 2 covered, September 21st 4 staff scheduled 3 covered, September 22nd 3 staff scheduled 2 covered, September 24th 4 staff scheduled 3 covered, September 27th 3 staff scheduled 2 covered, September 28th 4 staff scheduled 2 covered, September 29th 3 staff scheduled 2 covered , and September 30th 3 staff scheduled 2 covered. Based on the interviews provided and review of document the allegation of facility is not adequately staffed to meet resident's needs is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Allegation #2: Staff failed to keep facility free of scabies During LPA’s resident files review, LPA identify (4) residents to have had scabies while in care at the facility, resident #1, #2, #3, and #4 (R1, R2, R3, and R4). Statements provided by staff during interviews identified that facilities first scabies outbreak in memory unit was not reported to CCL as they though a single case was not considering an outbreak. As a result, the first resident who contracted scabies then spread it to 3 additional residents within the memory unit. Based on the evidence, statements, and records review the allegation # 2 of Staff failed to keep facility free of scabies is SUBSTANTIATED . A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Allegation #3: Staff are not ensuring that resident's linens are clean During interviews with staff it was communicated that the facilities washers and dryers are constantly inoperable resulting in linens and residents personal clothing not been readily available for use. Per, service request reviewed facility endure a 6-month period in which one of the main industrial dryers used for drying residents’ linens was broken. Per statements made by staff as a result of dryer machine not being available facility was not able to keep up with the demand for residents’ clean linens. Based on the evidence, statements, and record review the allegation #3 Staff are not ensuring that resident's linens are clean is SUBSTANTIATED . A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Allegation #4: Staff are not ensuring that resident's clothing is clean During staff interviews with 4 out of 8 staff, it disclosed that facilities washing machines and dryers have been in-operable or in need of repair for a prolonged period, as a result residents clean clothing needs were not being met. Furthermore, during this investigation documents provided to LPA reflect laundry equipment for the facility to be owned by a third party, who has not been consistent with workorders and repairs needed for their equipment. Based on the evidence, statements, and record review the allegation #4 Staff are not ensuring that resident's clothing is clean is SUBSTANTIATED . A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. An exit interview was conducted with Administrator, Annamarie Santos were a copy of LIC 9099, LIC 9099D, and personal rights were discussed and provided.