LPA interviewed S1 who stated that "all care staff have an assigned call answering device during the shift, and the care staff on duty checks it immediately. Caregiver remains awake throughout the night". LPA interviewed R3 who stated that he gets assistance from the staff and expressed no concerns. Review of Staff schedule revealed that one awake night staff is scheduled every night. LPA also checked and tested R1's buzzer, and the care staff arrived within minutes after the message was received.

Allegation: Due to lack of supervision, a resident goes into another resident’s room during day/night - Unsubstantiated

W1 stated that “a male resident with dementia wanders into R1’s room, taking her things and yelling.” During interviews, R1 stated, “It happened one time that R2 entered the room, but he was not yelling and left quickly. After that incident, staff made a plan, and now it doesn’t happen anymore.” During the interview, S1 confirmed that after learning about the incident, she increased supervision and redirected the wandering resident as needed.

LPA reviewed R2’s Needs and Services Plan. LPA observed that the care plan reflected increased supervision and behavioral monitoring for R2. LPA interviewed S1 who stated, “In collaboration with the physician, the care plan was updated to make sure we are appropriately serving R2.” LPA also reviewed staff training records, which were up to date and included training on resident supervision and dementia care. No ongoing incidents were reported or observed during the visit.

This agency has investigated the allegations above. We have found that the complaint was unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.