Complaint Investigation Report

Allegation #1: Staff do not ensure residents medical needs are met.

It is alleged that staff do not ensure residents medical needs are met. Regarding this allegation is it reported that Client #1 (C1) does not have primary care physician (PCP) and due to this facility staff have not taken C1 to doctor appointments, causing C1 to go without primary care. Interview with Administrator revealed that C1 did not have a PCP due to a delay with C1’s insurance carrier. C1 has insurance approved but not an insurance plan so that a PCP can be assigned to C1. Administrator stated that they are working with Department of Children and Family Services (DCFS) case worker to establish a PCP, however in the interim C1 has received care by numerous providers. DCFS case worker had been actively trying to get C1 additional funding through DCFS for PCP coverage, but at no point was C1 without care. DCFS case worker has been made aware of C1’s care the entire time and is well aware of the insurance coverage delay. LPA contacted DCFS case worker and case worker corroborated what Administrator stated. C1 has not gone without care and has been seen by numerous doctors to provide care, to include medical, dental and psychiatric care. LPA reviewed C1’s records that revealed C1’s insurance coverage and a statement that indicates that C1 does have a delay in insurance plan coverage. Additionally, Administrator provided documentation that reflects C1’s numerous visits to receive medical care confirming that there has not been a lack of ensuring that C1 receives medical care. Therefore, based on interviews, observations and record reviews this allegation is deemed unsubstantiated.