complaint·May 25, 2021

The complainant alleges: Facility failed to observe changes and that Facility failed to report observed change of condition. More specifically the complainant alleges that the facility has failed to observe changes in R1 and that Staff then failed to report changes in R1's status to their physcian. LPA interviewed staff who confirmed that R1, did have behavioral and physical health changes. LPA reviewed R1's Needs and Service Appraisal which indicates that the facility was aware of the residents change in condition and were providing services. In addition LPA reviewed a fax in which the facility notified the Physician of R1's health changes. Based on the documents reviewed and interviews LPA determined the allegation did not occur Therefore this is allegation is UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Executive Director's signature was not captured. A copy of the report was sent to Administrator. No deficiencies cited during today's inspection. Continued from 9099 It was alleged that the facility had Insufficient staffing. The complainant alleges that there were not enough staff on duty to support the residents needs in memory care. LPA reviewed facility time sheets and schedules for the week of 8/30-9/5/2020, interviewed staff and reviewed resident records. Per the Administrator, Assisted Living Staff are able to assist memory care staff when a need arises. Based on interviews and a review of facility records, LPA Walters was unable to determine that there was insufficient staffing therefore the allegation is UNSUBSTANTIATED. It was also alleged that the- Facility failed to report to licensing agency. The complainant alleges that the facility was not reporting reportable incidents to to Community Care Licensing. Based on a review of incident reports provided by the facility, Resident Care plans and charting notes. LPA was unable to determine that the facility did not report an incident that threaten the welfare, safety or health of any resident. Therefore this allegation is UNSUBSTANTIATED. It was also alleged that Staff are not properly storing medications. LPA Walters toured the facility on 9/22/20 and observed that all medication was properly stored in the medication room. Medications that were to be destroyed were stored in the cabinets of the medication room. In addition, LPA interviewed Executive Director and Staff who were unaware of medications being stored elsewhere. Based on interviews with staff, and LPA's observations, LPA was unable to corroborate the allegation occurred. Therefore allegation is found to be UNSUBSTANTIATED