Complaint Investigation Report

Regarding the allegation: Facility staff neglect resulted in resident being hospitalized for sepsis. It is alleged that facility staff failed to provide an appropriate level of supervision which resulted in the resident developing sepsis in the facility. According to staff statements (investigated by Real) Five (5) out of five (5) staff deny this allegation. The staff notified the hospice nurse and then called paramedics when hospice nurse was late to show. The staff also informed the family of the resident. Six (6) out of seven (7) residents interviewed could not collaborate the allegation. They had no knowledge. According to the family, resident was on hospice and had a history of non-compliance with dialysis. The hospice nurses and aids that saw the resident at/in the facility on a weekly basis did not observe any neglect or lack of care/supervision. A copy of Residents’ hospital records and hospice records were obtained and had no information to support the allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Regarding the allegation: Facility staff did not seek timely medical attention for resident. It is alleged that facility staff neglected to seek timely medical attention and treatment for resident in care. Resident was on hospice for heart failure. According to statements (investigated by Real) Five (5) out of five (5) staff deny this allegation. Facility staff stated, hospice staff visited the resident twice per week. Whenever the resident became ill or developed difficulty the hospice nurse was notified and instruct facility staff to administer supplemental medication, when pain did not subdue the paramedics were called and family is notified, never has the facility staff denied medical treatment for residents in care. Hospice staff interviews and documents reviewed. Hospice records confirm staff reported residents change in condition to hospice and was instructed to utilized supplemental medication, re-assessment of resident conducted by hospice nurse and called for paramedics when pain did not subside. Six (6) out of seven (7) residents interviewed could not corroborate this allegation. According to residents the staff has sought medical attention for residents when residents are in medical need. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.