It was alleged that R1’s bank was sending multiple rent payments to the facility, which totaled upwards in excess of over $50,000. It wasn’t until R1’s family member contacted the facility in which the facility confirmed that R1’s bank had indeed sent multiple payments. The LPA reviewed the invoice of R1’s rental payments to the facility from July 2020 – June 2022. R1’s balance at the start of October 2020 was $6,700, which was due to a missed rental payment in August 2020. However, a payment was received on 10/01/2020 and 10/30/2020 in the amount of $3,350 for each payment, which brought R1’s balance to $0. However, for the month of November 2020, R1 was charged the November rental fee of $3,350, yet R1’s bank sent two (2) payments to the facility in the amount of $3,350 on 11/04/2020 and 11/13/2020. At the end of November 2020, R1 had overpaid the facility by $3,350.

R1’s rate changed from $3,350 to $3,800 due to a change of services, as R1 began to receive tray services three times a day. Per interviews, this change was initiated by R1, as R1 did not eat in the dining room. As R1’s bank made a duplicate payment in November 2020, R1’s payments were current up until 3/1/2021. R1’s invoice indicated that R1’s bank did not send a payment to the facility for March 2021. However, in April 2021, R1’s bank made three (3) payments to the facility in the amount of $3,800 on 4/2/2021, 4/7/2021, and 4/9/2021. Further review confirmed that R1’s bank sent two (2) payments to the facility in the amount of $3,800 in May 2021, June 2021, and between the months of September 2021 – June 2022. Yet, this was not caught by the facility staff nor the licensee until R1’s family member contacted the facility about this error. The LPA reviewed a check that was paid out to R1’s family member, which totaled out to $52,750 on 6/22/2022. An interview with R1’s family member confirmed that R1’s bank had sent automatic payments but confirmed that the facility was unaware of this oversight in overpayments.

The Administrator stated that they did not know why R1’s bank had sent multiple payments. The Administrator believed that there was one time that a rent payment was late for unknown reasons, and the Administrator asked R1 to call their bank in order to remedy the situation. However, it is assumed that an additional automatic payment cycle was then set up. The Administrator admitted that the corporate office was responsible for completing and compiling invoices, and stated that their only responsibility was to scan over rent checks.

Continued on LIC 9099-C

Based on the information obtained in interviews and record review, there is insufficient evidence to support the claim that the licensee intended to financially abuse R1. As a result, the licensee regularly checks accounts to mitigate any similar issues of overpayment. This allegation is deemed Unsubstantiated at this time.

Regarding the allegations: (1) Due to neglect and lack of care, Resident #1 developed multiple wounds and (2) Staff failed to address resident medical needs, resulting in Resident #1 developing a fungus on multiple body parts

It was alleged that the staff neglected to address R1’s medical needs, which resulted in R1 developing a fungus on multiple body parts. A review of a Risk Assessment, which was completed upon R1’s admission to the facility on 3/18/2018, indicated that R1 did not believe in modern medicine and although they were considered pre-diabetic, R1 allegedly did not agree with the diagnosis. R1’s appraisal upon move-in indicated that R1 was independent and did not require assistance with activities of daily living. The LPA reviewed R1’s facility appraisals from 2018-2022 and per the appraisals, R1’s care needs did not change, nor did R1’s capacity to manage their individual needs independently. A review of R1’s facility documents confirmed that R1 was self-responsible and per the physician’s report completed 1/17/2021, R1 did not exhibit any cognitive delay. Interviews with the Administrator and a review of resident documents confirmed that R1 was not taking any medication and it was alleged that R1 did not have a prescribed doctor prior to admission to this facility in March 2018. However, records and interviews with the Administrator reported that R1 did not ‘believe in modern medicine’ and although R1 was considered diabetic, R1 refused to take medication to manage the condition.

An Incident Report dated 4/28/2022 reported that R1’s Doctor requested to see R1, as R1 regularly refused to see the doctor. Per the report, the doctor confirmed that R1 was diabetic and claimed that R1 needed to check their glucose daily.

**Continued on LIC 9099-C**

Interviews with staff and a review of care notes revealed that R1 allegedly refused to participate in body checks. As R1 did not require assistance with dressing, bathing, or grooming, staff were unaware of the fungus that developed on R1. Once it was observed, staff contacted the house doctor. However, R1 refused fungal treatment. On an Incident Report dated 5/20/2022, R1 was observed to have fungus on their feet. It was reported the resident’s doctor. R1 was recommended to go to a higher level of care to treat R1’s fungus. As a result, R1 was transferred to a higher level of care.

Based on the information obtained from interview and record review, there is insufficient evidence to support the above-mentioned claims. Staff interviews and records indicated that staff made regular attempts to meet R1’s needs. However, R1 exercised their right to refuse care. Once the staff were able to identify that R1 needed additional care, the staff sought out the facility doctor and R1 was transferred to a higher level of care. The allegations “Due to neglect and lack of care, Resident #1 developed multiple wounds” and (2) “Staff failed to address resident medical needs, resulting in Resident #1 developing a fungus on multiple body parts” is deemed Unsubstantiated at this time.

Regarding the allegation: Administrator failed to have knowledge with regards to residents’ physical and mental well-being and care needs

It was alleged that the Administrator was unaware of R1’s care needs, as the complainant alleged that R1 required significant assistance to meet their grooming and toileting needs. Interviews conducted with the Administrator confirmed that during the time that R1 was at the facility, R1 did not receive assistance with activities of daily living. However, R1 was physically and cognitively able to care for their own needs. It was noted that regarding R1, staff would communicate their concerns with the house doctor and would make recommendations to be seen, but R1 exercised their right to refuse.

**Continued on LIC 9099-C**

An Incident Report dated 4/28/2022 reported that the facility house doctor requested to see R1, as regularly R1 refused to see the doctor. Per the report, the doctor confirmed that R1 was diabetic and claimed that R1 needed to check their glucose daily. R1 allegedly claimed that they never took their medications as they did not believe in modern medicine. On an Incident Report dated 5/20/2022, R1 was observed to have fungus on their feet. It was reported to the facility doctor, and R1 was recommended to go to a higher level of care to treat the fungus. As a result, R1 was transferred to a higher level of care.

Information from staff interviews supported claims that R1 did not receive any assistance with dressing, bathing, grooming, or toileting. Staff noted that R1 was capable of carrying for their own needs and did not experience a change of condition that would have affected their capacity for self-care. Had this of happened, it would have been reported. Staff claimed that they would attempt to complete body checks with R1, but R1 would refuse such care and would claim to be ‘all right’ and not require additional assistance.

A review of skilled nursing notes confirmed that R1 was admitted to a nursing facility on 5/20/2022, with the admitting diagnosis of bilateral feet fungal infection and nail infection of the right ring finger. R1 did not arrive with any medications, but R1 was oriented to person, place, time, and situation and was able to communicate their needs. It was further documented that R1 required supervision/stand-by assistance with oral hygiene, showering/bathing, and upper body dressing. Staff at the nursing facility attempted to teach R1 about diabetic monitoring and practices, yet R1 initially ‘showed no interest’ in learning how to check their blood pressure. However, R1 became more compliant with the medication regimen as the weeks progressed at the skilled nursing facility. R1 never returned to the facility after being admitted to the skilled nursing facility on 5/20/2022.

**Continued on LIC 9099-C**

Administrator failed to treat residents and collateral agency representatives with dignity and respect

On the allegation of ‘Administrator failed to treat residents and collateral agency representatives with dignity and respect’, the RP’s concern is that the administrator is known to be rude and aggressive when speaking to collateral agency representatives and residents. To investigate the allegation the LPA’s conducted resident interviews and collateral agency representative interviews. The residents’ interviews revealed that they feel respected and cared for here, and they are treated with dignity and respect. Residents’ interviews revealed that they have never witnessed staff treat residents inappropriately. Interviews with staff revealed that the administrator is nice and respectful, and staff interviews revealed that they always treat residents with dignity and respect, even at times when residents are disrespectful. Additionally, collateral agency representative interviews denied claims that the administrator has disrespected them or failed to treat residents with dignity and respect. It was further communicated that the administrator has never been rude or disrespectful and that the administrator may have a strong personality to which can be perceived as discourteous. However, interactions with the Administrator have been deemed professional.

Based on the information obtained through interviews, there is insufficient evidence to support the allegation that ‘Administrator failed to treat residents and collateral agency representatives with dignity and respect’. Therefore, this allegation is Unsubstantiated at this time.

On the allegation that ‘Staff failed update appraisals to accurately reflect residents’ current physical and/or mental status’, it is the concern of the complainant that the appraisals did not accurately reflect the residents care needs. On 7/18/2022 the LPA’s obtained physician reports and appraisals for 78 residents.

**Continued on LIC 9099-C**

Based on the information obtained through record review and interviews, there is not sufficient evidence to support the allegation that staff failed to update appraisals to accurately reflect residents’ current physical and/or mental status. Therefore, this allegation is deemed Unsubstantiated at this time.

Staff failed to provide necessary care with activities of daily living to residents, including bathing, dressing, and grooming.

On the allegation that ‘staff failed to provide necessary care with activities of daily living to residents, including bathing, dressing, and grooming’, it is the concern of the complainant that residents are not being bathed, groomed or assisted with activities of daily living. On 7/18/2022 the LPA’s obtained physician reports and appraisals for seventy-eight (78) residents. In interviewing residents and comparing their appraisals with their documented care needs, the LPAs observed that the care needs identified in the appraisals aligned with the information received via resident interviews. Interviews conducted confirmed that residents were provided with assistance as described in their care plan, which could include assistance with bathing, dressing, eating, grooming, and other activities of daily living. Throughout the LPA’s visits, staff were observed escorting residents to mealtime and throughout the facility, staff assisted with grooming needs, and so forth. Residents appeared clean and well kept.

Based on the information obtained through record review and interviews, there is not sufficient evidence to support the allegation that ‘staff failed to provide necessary care with activities of daily living to residents, including bathing, dressing, and grooming’. Therefore, this allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted and a copy of this report was issued.