Complaint Investigation Report

Allegation: Facility director made inappropriate decisions for a resident to be placed at a different facility where the staff member later became a director.

Throughout this investigation, LPA conducted interviews with facility staff, former staff and Power of Attorney (POA) representatives. Additionally, LPA conducted a review of resident files. According to interview with the POA representatives, the decision to relocate R1 was based on the need for a higher level of care which the assisted living could no longer provide. POA representatives further explained that R1 needed to be place in memory care based on current assessment of R1’s Behavior Therapist.

The interviews further disclosed that while considering alternative placements at other facilities, the decision to move R1 to current facility was influenced by the recommendation of the former administrator, who had a positive relationship with R1. Additionally, it was clarified that the move was primarily driven by the need for memory care, which was not available at Chateau's at Rivers Edge at the time. Interview with current administrator confirmed that R1's relocation was necessary due to the requirement for memory care, which Chateau's did not offer at the time of the decision.

Review of R1’s care notes revealed that on 12/19/23, R1’s behavior therapist had informed facility staff that R1 is not suitable for the community (Assisted Living) due to R1’s cognitive state. Based on that, further review revealed that on 12/20/23, POA representative for R1 contacted the facility informing them that POA will be putting in 30-day notice for R1.

Based on all gathered information, the Department concluded that the allegation of inappropriate decision-making by the facility director regarding R1's relocation to a facility where they later became director is UNFOUNDED. The decision was justified by the resident's care needs and available placement needed at that time.