Complaint Investigation Report

Allegation: Staff did not ensure a client's postural support was properly used while in care.

The details of the complaint alleged that facility staff is not ensuring client’s postural support was properly used while in care.

During the records review, LPA Iniguez reviewed the following: (C#1)'s Home Health Plan of Care signed by MD on 10/24/23. In the plan of care for (C#1), it is prescribed by MD Durable Medical Equipment - Gait Belt with a start date of 10/24/2023 and no End Date. The goal is for (C#1) to ambulate 50 feet using FWW (belt), with the level of assistance: mod assist to allow ambulation within the B&C facility, to be achieved by date: 11/21/23.

On 6/6/24, when arriving at the facility, LPA Iniguez noticed (C#1) wearing their gait belt while seated in their wheelchair.

During an interview with the administrator (A#1), she stated that only one client uses postural support and is currently living in the community. Also, (A#1) stated that they do have on file a doctor’s order for (C#1)’s gait belt, and the facility staff just took training on April 24, 2024.

During an interview with client 1 (C#1), they stated that they use postural supports, and the facility staff assists them in using them. Also, (C#1) stated that they always wear gait belts. In addition, (C#1) stated that they like living at the facility.

During interviews with clients (C#2-C#4), (2) out of (3) stated that they do not use postural supports, but the facility staff helps them with their needs, and they like living at the facility. (1) out of (3) clients refused to be interviewed by LPA during the visit.