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This document w
as prepared by Residential Care Services for the Locator website.
Residential Care Services Investigation Summary Report
Provider/Facility: Hearthside Manor (699683) Intake ID(s): 3355204
License/Cert. #: AL2142Investigator: Goulet, Michael Region/Unit: RCS Region 3/Unit A Investigation
Date(s):07/18/201707/24/2017
through
Complainant Contact Date(s): 07/20/2017, 07/26/2017Allegations:1) Resident was left on mattress in facility lobby before and after resident's death
2) Family and primary care provider were not contacted regarding resident's change in condition
Investigation Methods:Sample: 1 of 1 residents, including
named residentObservations: General environment
Residents in their roomsStaff to residentinteractionsPlace in facility whereresident was stated tohave died
Interviews: StaffPersons not associatedwith the facility
Record Reviews: Progress notesInitial assessmentAdmission assessmentFacility investigationpaperwork andcommunicationsFire Dept. reportAlert charting notesCaregivercommunications formComplainantcommunication (viaattorney)Pre-admissionassessment (MedicalCenter)Service Agreement
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as prepared by Residential Care Services for the Locator website.
Residential Care Services Investigation Summary Report
MedicationAdministration Record
Allegation Summary:1) Per interview and record review it was determined that facility staff did leave the resident on a mattress on the floor of acommon area of the assisted living facility memory care both prior to, and after the resident's death.
2) Per interview and record review it was determined that the assisted living facility did not contact the resident's daughterregarding a change in the resident's condition. Per staff interview, one staff member did contact the resident's physician at aMedical Center regarding a request for medication orders related to the resident's condition, but this contact was not able to besubstantiated.
Unalleged Violation(s): Yes No
Conclusion /Action:
Failed Provider Practice Identified /Citation(s) Written
Failed Provider Practice Not Identified /No Citation Written
388-78A-2640 (1a) Reporting significant change in resident's condition70.129.140 (1) Quality of Life-Rights
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This document w
as prepared by Residential Care Services for the Locator website.
This document w
as prepared by Residential Care Services for the Locator website.
This document w
as prepared by Residential Care Services for the Locator website.
This document w
as prepared by Residential Care Services for the Locator website.
This document w
as prepared by Residential Care Services for the Locator website.