Complaint Investigation Report

During investigation, the department conducted interviews of facility staff & responsible parties and reviewed resident (R1) documents. Review of R1’s medical documents showed that on 12/06/22, R1’s doctor received a fax from facility staff (S1) who notified him about R1’s cough and congestion. Staff requested for cough syrup and an appointment with the doctor. Lab tests were ordered and a chest x-ray was performed on 12/06/22. The results of the chest x-ray showed R1’s lungs were clear and the pleura unremarkable. On 12/06/22, staff (S2) also notified the doctor when R1 developed a fever and staff gave R1 Tylenol which reduced her fever to normal. Staff continued to monitor R1 and on 12/07/22 at approximately 0500 hours, R1 passed away. Documents obtained do not suggest R1’s death was a result of neglect or lack of care for suspicious circumstances from facility staff. Review of death report showed immediate cause of death was acute hypoxic respiratory failure.

Based on records review, interviews conducted, and observations made, the department has investigated the above allegation of questionable death and found it to be unsubstantiated. A finding that the complaint allegation is unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation of questionable death is unsubstantiated.