Complaint Investigation Report

Regarding the allegation, ‘Staff did not inform authorized representative of resident's change of medical condition,’ the complainant’s concern is that the facility staff did not inform Resident #1’s (R1’s) authorized representative that R1 was hospitalized due to altered mental status and respiratory distress.

During the investigation, LPA Walker conducted interviews with R1’s family member(s), administrator, and facility staff. Interview with R1’s family member(s) revealed that the facility did inform R1’s authorized representative of R1’s change of medical condition, and staff took the steps to ensure R1’s received immediate care. Interview with R1’s family member(s) also revealed that R1’s family was contacted upon observing R1’s altered mental status and respiratory distress. R1’s family member(s) stated that they went the facility, and agreed with staff to call 9-1-1. Interviews with the administrator, and facility staff revealed that staff notified R1’s authorized representatives, and provided medical assistance in a timely manner to address R1’s change in of medical condition.

Based on interviews which were conducted, facility staff did inform R1’s authorized representative of R1’s change of medical condition. Therefore, there is insufficient evidence to support the allegation ‘Staff did not inform authorized representative of resident's change of medical condition.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time.

Regarding the allegation, ‘Resident #1 (R1) was placed on Hospice care without proper authorization,’ the complainant’s concern is R1’s authorized representative did not approve hospice care for R1 and were not aware that R1 was on Hospice.

During the investigation, LPA Walker conducted interviews with R1’s family member(s), administrator, and conducted a record review. Interview with R1’s family member(s) revealed that the facility staff did tell R1’s family member(s) of R1 being placed on Hospice; and was explained the process of Hospice care, before signing any documentation. Interview with R1’s family members also revealed that the Hospice authorization formed were signed upon admission to the facility. Interviews with the administrator revealed that R1 was placed on Hospice by R1’s family with the assistance of R1’s placement agent.