complaint·March 10, 2025

(Continue from LIC9099) It was specifically alleged that R1 was charged for a level of care increase on December 20, 2023, despite no documented change in R1’s medical condition per R1’s attending physician. However, a detailed review conducted on June 4, 2024, of R1’s medical records, health and service evaluations, and service care plans from May 16, 2022, through June 1, 2024, indicated a significant decline in R1’s medical condition (see details of the change in R1’s condition below). Additionally, a comprehensive review of R1’s account summaries and billing statements for the period in question (October 24, 2023, through June 1, 2024) confirmed that the charges accurately reflected the level of care provided by facility staff (see details of the billing statements below). Lastly, interviews with staff and with external sources did not corroborate the claim that R1’s level of care remained unchanged. Details of R1’s change in condition: The physician's report at the time of admission, dated July 6, 2022, indicated that R1 was diagnosed with Alzheimer’s disease, secondary diagnosis dementia with behavioral disturbance, hypertension, (high blood pressure), hyperlipidemia (abnormally high levels of cholesterol, triglycerides or other lipids in the blood), DYNA (group of serious and complex conditions that are caused by malfunction of the autonomic nervous system), CHF (congestive heart failure), COPD (chronic obstructive pulmonary disease), A-fib atrial fibrillation (irregular and rapid beating of the ventricles. On May 16, 2022, when R1 moved into the facility under the Memory Care level 2 service care plan. R1's responsible party reviewed and signed the service care plan on July 12, 2022. On September 27, 2022, R1’s assessment indicated a change in condition and an increase in level of care due to increased checks to 4x additional checks per shift. The prior assessment showed that R1 did not need additional checks. The service care plan was signed by R1’s responsible party on October 1, 2022. (Continue at LIC9099C) (Continue from LIC9099C) On March 24, 2023, R1’s assessment indicated a significant change in condition. R1's level of care increased to MC- level 3. The main contributing factor for the increase in the level of care was due to incontinence care increased to maximum assistance. R1’s prior assessment showed that R1 was independent in this category. In addition, R1 required daily assistance with special medications (creams and hydrocortisone cream). In the earlier assessment, R1 did not require any special medications. The service care plan was reviewed and signed by R1’s responsible party on March 24, 2023. On June 8, 2023, R1’s assessment showed a significant change in condition. R1's level of care increased to MC - Level 5, R1 required a higher level of care due to several medical condition changes. R1 required maximum assistance with special care needs, and R1 required daily assistance with oxygen use. The care team assisted in meeting R1's care needs with oxygen use to improve R1's quality of life. In addition, R1's change in condition required moderate assistance to provide frequent help due to disorientation, memory loss, difficulty completing tasks, increased episodes of memory, and/or cognitive impairment. Moderate assistance with wandering to other residents' rooms and R1 attempting to leave the building. R1 required daily intervention due to disruptive, aggressive, or socially inappropriate behavior. R1 care team was required to intervene due to R1's uncooperative and resistance to care, R1 had significantly increased levels of depression, anxiety, and/or mood disorder. The assessment and service care plan were reviewed with R1’s responsible party on June 8, 2023. On December 20, 2023, R1’s assessment showed a significant change in condition. R1's level of care increased to MC Level 7 (highest level of care). R1 required maximum assistance in all areas of care to meet R1’s needs. R1’s level of care increased with transfers from 0 to 60 maximum assistance due to requiring 2-person assistance due to R1 becoming non-weight-bearing. Assistance with mobility increased from 0 to 65 maximum assistance requiring 2-person assistance with observation and fall management. R1’s meals and nutrition needs increased from 0 to 30 maximum assistance requiring special cutting/preparing food (mechanically soft) and/or prompting throughout the meal. R1’s responsible party reviewed and signed the assessment and service plan on April 13, 2024. (Continue at LIC9099C) (Continue from LIC9099C) Based on the review of R1's billing statements and account summaries from October 24, 2023, through May 21, 2024, R1 was billed correctly according to R1's level of care as indicated on service care plans. Based on observations, interviews with key staff and outside sources, and a review of pertinent records there was insufficient evidence found to support the allegation that R1 was charged for services not rendered. Due to a lack of evidence, the allegation is deemed to be unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence that the alleged violation occurred. An exit interview was conducted with Business Office Director, Ellen Arguello to whom a copy of this report, LIC 811, and Licensee Appeal Rights (9058 03/22) were provided at the conclusion of the visit.