Complaint Investigation Report

Allegation: Facility charging resident for unneeded services.

Details provided indicated the facility charges resident for unneeded services. The complainant claims resident #5 (R5) is overcharged for unnecessary services. An interview with (R5) revealed that he signed a Residency Agreement. The Residency Agreement details what is covered under basic services. Any care services not included are itemized on the Resident Prospect Care Plan. A review of (R5’s) Physician’s Report LIC 602A listed his capacity for self-care and it is aligned with what is on the Resident Prospect Care Plan. (R5) states he is aware of the extra charges listed on Resident Prospect Care Plan and that the facility did not do anything underhanded. An interview with resident #6-#11 (R6-R11) all supported (R5’s) statement and included they do not know any residents being overcharged for unnecessary services. An interview with witnesses #1-#3 (W1-W3), family members for (R1-R3) all claimed they were made aware of all charges in writing during the admission process and stated the facility was transparent about any fees not covered under the basic services. An interview with staff #1-#5 (S1-S5) all verified that each resident goes through an extensive admission process which includes a personal assessment. At the time of agreement signing the resident or the designated representative will review a list of attachments and acknowledgments before the Residency Agreement is signed. (S1-S5) all confirmed there are no residents in this facility that is being charged for superfluous services. Staff #1 (S1) explained the care services at this facility is not in a set package; rather it is offered in separate items based on the resident’s service assessment and these services are listed on the Resident’s Prospect Care Plan with monthly prices.

Allegation: Staff is not properly assessing residents.

Facility retains residents with unstageable pressure injuries.

The complainant indicates the facility is non-compliant with its practices and is admitting or retaining residents due to low occupancy. The complainant alleges that residents #1-#2 (R1-R2) both residents admitted in July 2020 were not properly assessed during admission and had unstageable pressure injuries. According to medical service records (R1-R2) both completed assessments. (R1) had a Stage 2 pressure injury that was healing and was being assisted by Home Health when she was admitted. According to witness #1 (W1), family member for (R1) only live at this facility for 10 days.

EVALUATION REPORT CONTINUES ON LIC 9099-C