Complaint Investigation Report

Interviews and record review revealed that the facility uses a point-based system to determine each resident’s level of care. There are seven levels of care, with higher levels associated with higher monthly fees.

LPA review of R1’s admission agreement indicates that upon admission in November 2024 R1 was assessed at level 2 and a service plan states this is due to requiring assistance with medication management and cognitive/orientation. The admission agreement and facility rate card indicate that a level 2 care is a $1,300 monthly fee.

A reappraisal dated 10/30/2025 documented increased care needs, including full two-person assistance for bathing, grooming reminders, and additional support with other activities of daily living (ADLs). This reappraisal placed R1 at level 5 care. The facility rate card lists level 5 care at $3,050 per month. Interviews confirmed that the primary reason for the increase was to provide full assistance with bathing.

Facility account summary statements show that R1 began being charged at the level 5 care rate on 10/29/2025 until they moved out of the facility in April 2026.

The facility uses the August Health Care Tracker system to document staff assistance with ADLs. The facility provided logs showing consistent documentation of dressing and grooming assistance for R1; however, no entries reflect staff providing bathing assistance or R1 refusal of bathing assistance. Staff interviews indicated that an audit was conducted by corporate personnel. The audit showed that when the increased bathing needs were noted on R1’s service plan in November 2025 it was not transferred over to the care tracker system to notify staff R1 required assistance with bathing. When R1’s responsible party brought this to staff attention in March 2026, staff stated more of an effort was made to provide R1 assistance. The facility has since provided a partial refund for the increase.

Based on all interviews conducted and documents obtained, R1 was charged for increased level of care including bathing which they were not receiving from November 2025 to February 2026. At this time the above allegation was found to be substantiated , there is a preponderance of the evidence to prove that the alleged violation occurred.