Complaint·April 28, 2026

Regarding the allegation, staff do not ensure the residents toileting needs are met and staff refused to assist resident with dressing, according to the reporting party, R1 did not have available diapers in his/her personal supply bag, and the diapers present were not appropriately sized for R1. Staff were asked for assistance in dressing R1 prior to discharge, however staff declined stating R1 was able to dress himself/herself. I requested staff assistance in helping Mr. Hill dress prior to discharge; staff declined, stating that he was able to dress himself. During the investigation, LPA interviewed staff, reviewed R1's file and attempted to interview R1's responsible party. LPA was unable to interview R1 as R1 is no longer a resident at the facility and R1's responsible party was not responsive. Based on R1's physician's report dated 3/11/25, R1 is able to dress himself/herself and care for his/her own toileting needs. According to R1's service plan dated 10/23/25, R1 is independent with dressing and toileting tasks. Based on staff interviews, R1 was assisted with dressing and changing of his/her diaper as R1 would wet himself/herself. Staff indicated if a resident is independent with toileting and dressing, however a resident needed assistance, staff would always help. In addition, staff indicated, there were always extra diapers at the facility and previous staff were in charge of ordering it for R1. Regarding the allegation, staff did not ensure resident wound care needs were met and staff did not ensure resident's hygiene needs were met, according to the reporting party, during hygiene care at R1's new facility, staff observed s ignificant physical concerns, including large open wounds on R1's back, scabbing and wounds present on ears, overgrown toenails, and fingernails with visible debris underneath. R1's hair and facial hair were overgrown, and his/her overall presentation was consistent with poor hygiene. During the investigation, LPA interviewed staff, reviewed R1's file and attempted to interview R1's responsible party. LPA was unable to interview R1 as R1 is no longer a resident at the facility and R1's responsible party was not responsive. Based on R1's physician's report dated 3/11/25, R1 is able to bathe and groom himself/herself. According to R1's service plan dated 10/23/25, R1 is one persons assist with showers and received showers every Monday and Friday in the PM. Based on staff interviews, staff were not aware of any wounds that R1 had while at the community. Staff indicated that R1 would receive showers 1-2x a week, however at times R1 would refuse. Based on documents reviewed and interviews conducted, the department has determined that although the above allegations may have happened or is valid, there is no a preponderance of evidence to prove the alleged violation did or did not occur, therefore the above allegation is UNSUBSTANTIATED. Report is reviewed with administrator and a copy is provided.