Complaint Investigation Report

Regarding the allegation that licensee did not allow staff to call 9-1-1, an interview with staff revealed that Resident #1 (R1) was not acting like their usual self in getting ready to attend Day Program. [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] Staff reported that R1 was not eating and not wanting to get dressed or shower which is out of character for R1. Administrator reported that the situation was not life threatening, R1 was breathing fine, and R1 stated they did not want to call an ambulance, so staff were instructed to take R1 to the hospital for further evaluation. Staff immediately took R1 to the hospital. LPA interview with R1 who corroborated that he did not want an ambulance to be called and staff took him to the hospital that morning. An interview with an Outside Source (OS1) familiar with R1 and the facility did not report concern over facility staff historically not calling 9-1-1 when necessary.

Regarding the allegation that staff abandoned resident in care, specifically that staff abandoned R1 at the hospital, LPA interviewed the Reporting Party (RP) of this allegation, who reported they were told about the alleged incident and did not witness it themselves. Staff interviews revealed the following timeline: staff took R1 to the hospital and were told they could not accompany R1 beyond the waiting room. Staff were told that their car at the entrance of the hospital had to be moved. Staff provided hospital personnel with R1’s medication list and then left to move the car. By the time the car was moved, the Administrator had arrived at the hospital and entered the hospital with staff to check on R1 and provided hospital personnel with more information regarding R1’s medical history. An interview OS1 reported that facility staff take great care of the residents and does not believe staff would willfully abandon any residents in care.

The Department has investigated the allegations that licensee did not allow staff to call 9-1-1 and that staff abandoned resident in care. Based upon the information obtained during this investigation, it is determined that the preponderance of evidence was not met to support or corroborate these allegations and therefore deemed unsubstantiated.

An exit interview was conducted with Roosevelt Edwards House Manager, to whom a copy of this report and the Licensee’s Rights (LIC9058 01/16) were provided.