Complaint Investigation Report

It was reported that “Staff do not prevent a resident from causing harm to other residents while in care”, as it was alleged that that due to lack of staff supervision Resident #1 (R1) and Resident #2(R2) were physically assaulted by Resident #3(R3) on separate occasions. R2 and R3 were roommates during the time of the complaint. On 02/22/2023, at approx 4 p.m. R2 and R3 were reported to have an argument in their shared room, which resulted in R3 striking R2 with a cane on their face. R2 immediately went downstairs to Staff and received first aid then was admitted into a local hospital. It was also reported that R3 kicked R1 on the back of their wheelchair. LPA's interview with R1 revealed they do not recall their wheel chair being kicked by R3 or having any physical altercation with any resident at this time. LPA's interview with six (6) residents in care who resided at the facility at the time of the complaint revealed that all six (6) residents did not express any potential or immediate concerns for being involved in a physical altercation due to lack of staff supervision. Furthermore interviews with all (6) residents stated they have always observed staff intervene when residents were observed to be overly aggressive with other residents. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation, “Staff do not prevent a resident from causing harm to other residents while in care” is deemed Unsubstantiated at this time.

It was reported that “Staff did not meet the medical needs of the residents while in care”, as it was alleged that a med tech was not available to administer medications on 03/13/2023. It was also stated that a med tech not being available has occurred on multiple occasions. Interviews conducted and records review revealed that there is at least one (1) med tech per shift with five (5) med techs on staff along with an LVN. Interviews conducted with six (6) residents in care who resided at the facility at the time of the complaint revealed that four (4) out of the six (6) residents interviewed have never missed a medication dosage due to a med tech not being available. LPA's interview with two (2) out of the (6) residents revealed they have not experienced missing a dosage of medication due to a med tech not being available, however they have experienced a delay in receiving their medications due to a med tech arriving late to work. Those (2) residents continued to state it does not occur often and they recall they did not have to wait more than 30 mins from their typical time of administration. LPA's records review of six (6) resident Medication Administrator Records (MARS) dated 03/13/2023 revealed that all (6) residents received their medications as prescribed..