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32 | Regarding the allegation that Staff did not ensure resident’s care plan is being followed, it was reported that resident is neglected and does not get changed for hours. Resident #1 (R1) stated that they are stuck in soiled briefs for a long time before staff comes and changes them. Per review of R1’s physician’s report, R1 is diagnosed with Multiple Sclerosis, is nonambulatory, and unable to care for their own toileting needs. Per review of progress notes, it was noted that resident has been refusing assistance with personal hygiene on March 31, April 15, April 19, April 22, May 4, May 5, May 14, June 5, and June 13, 2026. It was reported on multiple occasions that R1 is verbally aggressive and uses profanity against staff. Two out of four residents interviewed stated they are changed daily, or as requested. Two out of four residents responded with unrelated information. Five out of five staff, including the administrator, reported R1 refuses to be changed. The administrator reported that R1 has developed a rash due to the soil they have been sitting on. None of the evidence gathered supports the allegation.
Regarding the allegation that Staff does not ensure soiled garments are removed from the resident’s room, it was reported that staff leaves soiled diapers and towels in resident’s room. Per review of R1’s admission agreement dated March 26, 2026, the facility will provide weekly housekeeping services and the resident agrees to keep their room in a clean and sanitary condition. One out of four residents stated that sometimes there are soiled diapers or towels left in the room. Two out of four residents denied the allegation. One out of four residents provided irrelevant information on the allegation. Three out of five staff denied the allegation. Two out of five staff stated that soiled garments are placed in a bag and disposed of at a later time because the washers are in use.
Regarding the allegation that Staff do not ensure resident’s personal belongings were kept safely secured, it was reported that staff threw away personal towels and damaged clothing items while assisting resident with changing shirts. When LPA interviewed R1, it was reported that staff steal their clothes after washing them and comes into their room to take their pants and shirts. Per review of admission agreement, theft will result in staff’s immediate loss of privileges to enter the facility to provide services to any resident. It was further stated that the facility shall not be responsible for the loss of any personal property belonging due to theft, unless the loss or damage was caused by the facility’s negligence or that of employees. Two out of four residents stated they have had belongings stolen at the facility. Two out of four residents stated they have not had belongings stolen. Three out of five staff interviewed denied the allegation. One out of five staff interviewed did not provide relevant information. One out of five staff interviewed stated that there was a time where R1’s cushion pillow was washed and dried, but staff did not know who it belonged to because there was not a room number attached to the laundry bag. The item was later returned to R1. Cont. on LIC9099-C.
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