Regarding the allegation that staff does not provide activities for R1, interviews reported that staff provide daily activities such as coloring, arts and crafts, ball play, board games, and range-of-motion exercises. Staff explained that while R1 is unable to fully participate in many structured activities due to R1’s condition, staff consistently offer individualized engagement, including taking R1 outside for fresh air, providing range-of-motion exercises, offering fidget items and simple coordination tasks, and speaking with R1 throughout the day. Staff stated that they have attempted activities requested by R1’s responsible party, however, R1 does not have the physical capacity to complete several of these tasks, and activities are adjusted based on R1’s abilities.

Records review of R1’s Needs and Services Plan reflects that R1 requires total assistance with activities of daily living and that staff are to provide routine range-of-motion exercises, supervised outdoor time, and daily supervised social engagement consistent with what was described during interviews.

Regarding the allegation that staff do not transfer resident in a safe manner, interviews did not corroborate the allegation, as staff reported that they are trained to use a facility Hoyer lift and have used it for R1, particularly after R1’s responsible party expressed a preference for transfers to be completed with the lift. Interviews indicated that R1 has consistently had a two-person assist since admission, and although staff initially attempted transfers without the lift during the first days of R1’s stay, they began using the Hoyer lift once this preference was communicated. Staff stated that the lift is kept accessible in the hallway due to limited space in R1’s room.

(Cont. on LIC 9099-C pg. 1)

Regarding the allegation that staff are not adhering to resident's dietary needs, interviews reported that staff follow R1’s prescribed minced-and-moist diet and have been preparing foods consistent with R1's medical provider's guidance. Staff stated they mince foods finely, add moist components such as mayonnaise, separate items when requested, and adjust textures based on R1’s chewing ability. Staff also reported ongoing communication with R1’s responsible party, sending pictures of R1's food frequently to ensure accuracy. Records review of R1’s Needs and Services Plan and Physician’s Report showed that R1 requires a soft/minced/moist diet with thin liquids. Records review of text and email correspondence revealed numerous photos of R1’s meals, demonstrating foods chopped into fine pieces with moist mixtures.

Based on interviews, observations, and record review, the preponderance of evidence standard has not been met, therefore the above allegations are found to be unsubstantiated. An exit interview was conducted with Administrator Travonna Washington and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided. Their signature confirms receipts of these documents.