complaint·August 8, 2024

[Continued from LIC 9099] Regarding the allegation, resident (R1) eloped from the facility due to lack of care and supervision, it was reported that R1 left the facility unattended and sustained a scratch to the arm due to a fall. It was reported that R1 was located but continues to elope from the property. Records review revealed that R1 has a diagnosis of Dementia and is unable to leave the facility unassisted. Records review revealed that facility issued a 30-day notice to R1 due to R1 requiring a higher level of care for exit seeking behaviors. Interviews with staff revealed that R1 has began exhibiting exit seeking behaviors but has never been out of staff sight. Staff report that they will follow R1 when R1 exits the facility and will redirect to come back. Staff reported an incident where R1 was observed with a scratch to the arm but was unable to determine where/how R1 sustained the scratch. No reports of anyone observing R1 off facility property. Staff reported no concerns for lack of supervision. Interview with R1 reported that they have never been out of the facility unassisted and reported that staff will accompany if they want to go for a walk. R1 reported having no concern for lack of supervision and reported that staff are “helpful”. R1 stated they do not recall an incident where they fell and sustained a scratch to the arm. Interview with outside source revealed no concern for the facility. Regarding the allegation, staff did not follow reporting requirements, it was alleged that facility staff were instructed my management not to report an incident where resident was AWOL (absent without leave) from facility. Interview’s with staff revealed that staff have never been instructed by management not to report something. Facility staff reported that there was some confusion amongst staff about what is considered a reportable AWOL and what is not. Facility reported that staff were re-trained on AWOL procedures, and it was made clear that once a resident is not being supervised by a staff member it is considered an AWOL. Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid. No deficiencies were cited today. An exit interview was conducted with Mitchell. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Mitchell whose signature below verifies receipt of these rights.