Complaint·November 14, 2024

On the allegation: Staff did not seek medical attention in a timely manner for resident after a fall. LPA conducted interviews with staff and witness that revealed Resident 1 (R1) did have a fall in the early morning, R1 was not wearing R1's pendant to call for help, R1 was on the floor calling for help for an unknown amount of time, and the facility did not call 911 or seek medical attention for R1. R1 had another fall that afternoon and 911 was called to transport R1 to the ER. Based on the evidence this allegation is Substantiated at this time. On the allegation: Facility failed to report incident to Residents responsible party and Licensing. LPA conducted interviews with staff which revealed no 911 or medical visit was made for R1 after the 1st fall, R1's 2nd fall was reported immediately to R1's family. Incident report for either of R1's falls on12/30/2024 were not reported to Community Care Licensing (CCL). Witness 1(W1) interviewed revealed a call was made to W1 in the late morning 12/30/2024 regarding a fall for R1, R1 was fine, got cleaned up and taken down to breakfast. W1 stated later that afternoon W1 was immediately called about R1 having another fall and was being transported to the hospital. Based on the evidence and lack of facility records provided this allegation is Substantiated at this time. On the allegation: Facility failed to report resident death to Licensing. LPA conducted interviews with staff and requested records of death report for R1. The facility was unable to provide a copy of the death report. W1 stated the facility staff was told about R1's death in the hospital within the days proceeding the death of R1, W1 cleaned out R1's room and gave away some of R1's belongings so certain staff knew of R1's death at that time. W1 stated R1's death was reported to management within the week of R1's passing. Based on the lack of records provided and CCL not having a death report on file this allegation is deemed Substantiated at this time. Exit interview conducted, deficiencies cited, copy of report and appeal rights printed for administrator. On the allegation: Facility denied care and supervision services after resident was discharged from the hospital. LPA interviewed staff which revealed no staff denied care or supervision services after a residents discharge, Staff stated they would provide the services immediately and let business staff know to up date care services on resident 1 (R1). Staff stated they understand the procedure to provide care immediately and business office sends a letter to resident and responsible parties of care fee increase. Witness 1 stated after discharge a staff told W1 they could not provide additional care services to R1 until the next business working day W1 would have to sign up for additional care services at that time. LPA reviewed R1's Admission Agreement and in Appendix A there is a clause that states Additional "Round the Clock" care the facility would provide the service for a fee of $25.00, the fee would be billed to the family on a weekly basis and will be expected to be paid within three days of receipt. Based on the lack of evidence this allegation is Unsubstantiated at this time. Exit interview conducted and copy of report printed for Administrator.