Complaint Investigation Report

(PAGE 2) REPORT CONTINUED FROM LIC 9099...

During today’s visit, at 10:36 a.m. LPA conducted a physical plant tour to ensure there are no immediate health and safety concerns and facility is in compliance with Title 22 Regulations, at 11:15 a.m. conducted an in-person interview with one (1) staff, at 11:32 a.m. conducted a file review, and obtained copies of pertinent documents relevant to the investigation.

On the allegation Staff does not have sufficient training, it is the concern of the Reporting Party (RP) that the facility staff does not have a description of a plan for providing training required for all direct care personnel to meet individuals' needs and Staff in-service or programming related to community services (and implement health care plans) for Resident #1 (R1) and resources particularly in related to community integration and activities that will help meet the residents IPP goal and social needs. To investigate this complaint, LPA conducted an audit on the facilities in service trainings and a file review including R1. Audit revealed that the facility has not conducted staff in-service training or programming related to community services and resources, particularly in relation to community integration and activities that will help meet the residents IPP goal and social needs posing a potential health and safety risk to clients in care. Audit revealed that the facility does not have a description and plan for training and competency to meet health care needs for R1 and the use of APAP and oxygen saturation monitoring and use specific to R1. Based on information obtained, audit preformed and a credible witness there is sufficient evidence to support the allegation occurred. Therefore, the allegation of Staff does not have sufficient training is deemed substantiated at this time.

On the allegation the facility has Insufficient Staffing, it is the concern of the Reporting Party (RP) that the facility is not sufficiently staffed. To investigate this complaint, LPA conducted a file review including R1 and R2. Based on file review in the name of the Individual Health Care Plan ( IHCP) team member, and an alternate designee, who is responsible for day-to-day monitoring of the consumer's health care plan and ensuring its implementation as written. R1 should have both health care plan team members listed as Registered Nurses (RN’s) however R1 only has one (1) RN listed posing a potential health and safety risk to clients in care. File review on Resident #2 (R2) should have an alternate designee, who is responsible for day-to-day monitoring of the consumer's health care plan however only one (1) RN, IHCP team member is identified responsible for the day-to-day monitoring of the resident’s health care plan and ensuring implementation.