1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32 | Witness (W2) reported one statement allegedly made by staff (“shush” or “shut up”); however, W2 did not witness any abuse and reported no additional concerns. W2 further stated the resident can be difficult at times and may have misinterpreted staff statements, including possibly hearing “hush” instead of “shut up.” (W3) reported not witnessing any concerns firsthand and only received information from a third party. W3 declined to provide additional details. Staff (S1–S4) denied the allegation. Residents interviewed (R1–R3) indicated staff are respectful. Observations revealed the following: Staff were observed to be calm, respectful, and attentive to residents. No observations were made that support staff mistreatment. Records review revealed the following: No documentation was found supporting the allegation of verbal abuse. The resident’s records indicate mild cognitive impairment, history of anxiety, and significant medical decline, which may impact perception and reporting. Based on the evidence gathered, interviews conducted, observations, and records reviewed, although the allegation is valid and may have occurred, there is not a preponderance of evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated.
Regarding the allegation “Staff refused to give resident water,” it is being alleged that staff denied the resident hydration upon request. Interviews conducted revealed the following: Staff (S1–S2) reported that residents are routinely encouraged to drink fluids. Residents interviewed (R1–R3) reported they receive water and did not express concerns regarding hydration. No witness reported denial of water. Observations revealed the following: Water was observed to be accessible in resident rooms and dining areas. Residents had water available at bedside. Based on the evidence gathered, interviews conducted and observations although the allegation is valid and may have occurred, there is not a preponderance of evidence to prove the alleged violation occurred. Therefore, the allegation is unsubstantiated.
Regarding the allegation “Staff gave resident medication without authorized representative consent,” it is being alleged that the resident was administered (Ativan) without consent. Interviews conducted revealed the following: Witness (W1) did not witness medication administration and reported secondhand information. Staff (S1–S4) reported medications are administered per physician and/or hospice orders. Observations revealed the following: Medications observed on site were consistent with physician orders. Records review revealed the following: The resident’s records and hospice documentation indicate the resident was under hospice care, and medications observed were consistent with treatment for the resident’s medical condition. Lorazepam (brand name Ativan) was observed among the residents’ medications and is consistent with physician and hospice-ordered treatment.
Please see report continuation on (LIC9099-C) |