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dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

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Page 1: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

Page 2: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

Page 3: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

Page 4: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

Page 5: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

Page 6: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

Page 8: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

Page 9: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

Page 10: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

Page 11: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

Page 12: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

Page 13: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

Page 14: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

Residential Care Services Investigation Summary Report

Provider/Facility: THE LODGE AT ARBOR VILLAGE(688421)

Intake ID(s): 3600984

License/Cert. #: AL2037Investigator: Hayes, Mary Region/Unit: RCS Region 2/Unit D Investigation

Date(s):12/28/201801/23/2019

through

Complainant Contact Date(s): 01/23/2019Allegations:1. Named resident presented to the emergency room for wound care.2. It was reported the facility was trying to get rid of Named resident (Alleged victim-AV) because they no longer wanted to takecare of AV.

Investigation Methods:Sample: Named and one other

residentObservations: Environment-secured

memory unit, staff-resident and resident-resident interactions,basic wound observationof other sampled resident

Interviews: Administrative, nursingand care staff, personsnot affiliated with thefacility

Record Reviews: Policy and procedures forpreventing/protectingresidents fromabuse/neglect, Disclosureof services, woundmanagementcare/instructions,Department's recentStatement of Deficiencyrelated to wounds

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Residential Care Services Investigation Summary Report

Allegation Summary:1. Named resident lived in the facility for over 6 months. She had a history of chronic/recurring wounds and had recentlydeveloped two new ones. Nursing staff monitored and eventually contracted wound care out to a home health agency. Thehome health agency recommended additional and further evaluation/treatment as a result of poor healing. The AV had beenincluded in the Department's full inspection sample and the facility's corrective plan was still within their window for reachingcompliance.2. Named resident was no longer in the facility and was not interviewed. The Disclosure of services indicated the facility couldand would not be able to care for Stage III or IV wounds. The emergency room discharge and facility staff discussed housingoptions with the Power of Attorney (POA). There were no discharge documents to review because the facility had not provided adischarge notice. The POA found a suitable housing option and the AV was moved within 72 hours of being seen in theemergency room.

Unalleged Violation(s):None.

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

Page 2 of 2

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Residential Care Services Investigation Summary Report

Provider/Facility: THE LODGE AT ARBOR VILLAGE(688421)

Intake ID(s): 3596746

License/Cert. #: AL2037Investigator: Hayes, Mary Region/Unit: RCS Region 2/Unit D Investigation

Date(s):12/28/201801/23/2019

through

Complainant Contact Date(s): 12/18/2018Allegations:Named resident/Alleged Victim (AV) presented to the emergency room after an unwitnessed fall in a stairwell (falling up to 8steps)

Investigation Methods:Sample: Named resident Observations: Environment, stairwell A

and B, staff-residentsupervision andinteractions, roomsadjacent to the unlockeddoor to the stairwells, calland alarm systems inmemory care, resident-resident and staff-residentinteractions/activities andgeneral residentgrooming andappearances

Interviews: Administrative, nursing,care and maintenancecrew, marketing director,persons not affiliated withthe facility

Record Reviews: Administrativepolicy/procedures relatedto abuse/neglect,Disclosure of Services,information related tosecured unit(s), incidentreports, witnessstatement, resident(respite) recordsincluding medication,

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Residential Care Services Investigation Summary Report

assessment and careplans

Allegation Summary:Named resident (AV) was admitted to the facility as a respite resident with a history of having poor safety awareness. AVexhibited exit-seeking and wandering behaviors and observed by staff walking down the hallway trying to access the doors toresident bedrooms. AV used a mobility device for stability and balance and needed cueing assistance with most activities ofdaily living, such as grooming, toileting and navigating her environment. In interview, the facility oriented the resident to herroom and immediate environment, staff monitored her for safety; however, the stairs leading to the outside had anunlocked/unsecured door, allowed AV access the open, stairwell and AV fell. There was no system for preventing residents directaccess to the stairwell and the alarm system did not alert or facilitate staff awareness in a timely manner of the resident'swhereabouts to prevent the fall.

Unalleged Violation(s):None.

Yes No

Conclusion /Action:

Failed Provider Practice Identified /Citation(s) Written

Failed Provider Practice Not Identified /No Citation Written

See Statement of Deficiencies, completion date 1/23/2019.

Page 2 of 2

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

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Page 31: dZ] } µu v Á ÇZ ] v ]o ^ À] (} Z >} } Á ] X · Residential Care Services Investigation Summary Report assessment and care plans Allegation Summary: Named resident (AV) was admitted

This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

as prepared by Residential Care Services for the Locator website.

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This document w

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