Failure to Properly Investigate and Resolve Resident Grievances
Penalty
Summary
The facility failed to ensure that resident grievances were properly followed up, investigated, and resolved for three residents and over three months of Resident Council meetings. Specific grievances included complaints about cold and sometimes frozen meals, inadequate showering opportunities, and insufficient room cleaning. The facility's grievance logs showed that while some resolutions were noted, such as conducting audits, temperature checks, and instructing staff to offer showers or clean rooms, the documentation of follow-up actions and investigations was vague and lacked detail. Resident Council minutes also reflected ongoing concerns about food quality, temperature, and variety, with repeated issues being raised over several months. Confidential interviews with residents further corroborated these concerns, with reports of consistently cold and inedible food, lack of alternative meal options, and improper diets being served. The Administrator acknowledged that responses to grievances and Resident Council concerns were not specific and that staff documentation did not clearly outline the actions taken to address the complaints. The facility's own grievance policy required prompt efforts to resolve grievances, thorough documentation of investigations, and communication of resolutions, but these standards were not met in the reviewed cases.