Complaint Investigation Report

Interview with S1 and Administrator revealed that R1 sustained injuries to left eye and a scratch above left eye, however, actual dates of occurrence were not recalled. Police report reviewed states that R1 sustained injuries due to a fall which would have occurred within few days of the 12/26/21 date. Based on interviews with S1, S2, and Administrator, and based on record reviews it was revealed that there were no witnesses to a fall of R1. Interview with R1 also revealed no recalled history of negative interactions with staff members. Interviews with S1, Administrator, R1 and R2 revealed a physical encounter occurred between R1 and R2 which led to an injury of R1 on an unknown date but discovered on 12-26-21. Additionally, it was determined through interview of S1 and Administrator that staff did not immediately intervene during the actual occurrence of the encounter between R1 and R2. It was further discovered through interviews that only 1 staff member was on duty during the encounter, while originally two staff members are present to provide care and supervision. Additionally, it was discovered through record review that R1 has a history of aggressive behaviors towards others. As a result of the interviews conducted and records reviewed, it is determined that R1 sustained injuries while in care during staff presence, and as a result of untimely intervention during the encounter between R1 and R2. Therefore, the preponderance of evidence standard is met and this allegation is SUBSTANTIATED.

Allegation #2: Staff did not maintain proper records of resident’s centrally stored prescription medications. LPA reviewed medication centrally stored medication list and compared information from list to medication observed during medication audit. Based on record review and observation, it is determined that expiration dates for medications, date filled for medications, and start dates for medications did not accurately reflect the dates noted on the medication labels. As a result, the preponderance of evidence standard is met. Therefore, this allegation is SUBSTANTIATED.

Deficiencies are cited today under Title 22, Division 6, Chapter 8. An exit interview was conducted with Adetayo Kokumo and a copy of this report was given to Adetayo. Appeal Rights provided.