Complaint Investigation Report

Residents are not receiving assistance with incontinence needs.

Based on interviews conducted the allegation of Residents are not receiving assistance with incontinence needs is SUBSTANTIATED. Information provided that at the time of LPAs visit resident had not been assisted with being changed for the day and it was 1:32pm. LPA inquired about what happens during the night and feedback provided was that staff do not come to the resident bedrooms.

Staff do not respond to residents' call for assistance.

LPA conducted interviews the information provided was that during the night, staff are not responding to the bells when they are rung. Due to only one staff being on during the evening, and per the facility program plan the night staff is expected to be awake. However, it was reported that that during the evening staff are not responding when assistance is requested. Additionally, it was reported that staff are not making their rounds during the evening. Therefore, the allegation of Staff do not respond to residents' call for assistance is SUBSTANTIATED.

Staff are not assisting residents' with hygiene needs.

Staff reported that the residents are given their baths in the morning after they wake up and if there was an “accident” depending on the severity an additional bath is given. LPA conducted interviews and reviewed resident files two (2) of the three (3) residents are not receiving any outside services such as home health or hospice. It is solely the facility staff responsibility to assist residents with their hygiene needs. It was reported that there are no showers being given, not even bed baths, just a wipe down, and when it does happen it isnot thoroughly. It is important to note that the two non-ambulatory residents do need two staff to assist them, however there is only one staff on during the shift at a time. Based on the information provided the allegation of Staff are not assisting residents' with hygiene needs is SUBSTANTIATED.

Facility does not provide meals of the quality and quantity to meet the needs of the residents. Information provided was that the food being served is old, rotten, and cold. LPA observed a container of Macaroni and Cheese that expired on December 4, 2021. During interviews conducted it was shared that the meals used to be complete and would be stored