Complaint·April 9, 2025

As part of the investigation, LPA interviewed R1, the administrator, staff member and review documentation, LPA interviewed R1 who stated that facility staff was providing good care and R1 was comfortable at the facility. The administrator denied the allegation and stated that R1 was admitted with a pressure ulcer and home health nurse was providing treatment to the wound. However, R1 was not compliant with being turned and repositioned resulting wound got worse. The administrator stated that this observation was noted and documented by the home health nurse and facility staff. LPA interviewed staff #1(S1) who stated that they turned and repositioned R1 every 2 hours but sometimes R1 did not want to comply, but they continued to encourage. S1 stated that R1’s wound was being treated by the home health and hospice nurses. Based on documentation provided by the facility, it revealed that R1 was refusing to be turned by the facility staff and refused pressure injury prevention measures that were recommended by the home health nurse. After the investigation, this allegation is deemed to be unfounded as R1 stated that he/she was comfortable and facility staff was providing good care. In addition, facility documentation indicated that R1 was refusing pressure ulcer prevention measures and safety precautions. The Department has investigated the complaint allegations of possible physical plant violations. It was determined the allegations are unfounded, meaning the allegations are false, could not have happened and/or is without a reasonable basis and therefore dismissed.