Complaint Investigation Report

On 09/20/2021 record reviews indicate that the medications listed on the hospital records, physician’s report and Highland Manor Guest Homes medication administration records (MAR) are the same. The MAR indicate that C1 was given their medications as ordered by the prescribing physician. Regarding the allegation: Staff gave resident the wrong medication. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: Facility is unkempt. On 09/14/2021 the department received information that C1’s room was very dirty and unsafe. On 09/16/2021 6 out of 10 clients stated that staff came in daily to clean their rooms, 3 out of 10 clients stated that staff did not regularly come to clean their rooms and 1 out of 10 clients stated that staff never came in to clean their room. On 09/27/2021 S2 stated that “C1’s room was always clean, housekeeping would always go and clean their room." On 09/28/2021 S1 stated “C1 kept food in their room, I remember seeing some spoilt food and watermelon in the room I let Aaron know and he had it cleaned." On 09/28/2021 record reviews indicate that C1’s room was cleaned daily 3 weeks prior to their hospitalization. Regarding the allegation: Facility is unkempt. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited. An exit interview was conducted, and a copy of this report was provided.