Failure to Document and Address Resident Council Concerns
Penalty
Summary
The facility failed to ensure that concerns raised by the Resident Council were thoroughly documented and that residents felt their concerns were acted upon in a timely manner, including providing clear facility responses to the group. Resident Council meeting notes over several months showed that while some concerns, such as laundry issues and call light response times, were acknowledged, the documentation of follow-up actions and specific resolutions was inconsistent or missing. For example, concerns about missing clothing, physician (MD)/nurse practitioner (NP) responsiveness, and housekeeping were either not addressed in the meeting responses or lacked evidence of follow-up or resolution. During interviews, residents reported that their concerns were not thoroughly addressed, with some stating they had not received any outcome or follow-up regarding missing items or issues with meeting their facility physician. Residents also expressed frustration that they had to repeatedly bring up the same concerns at multiple meetings, indicating a lack of effective resolution. The Activities Director confirmed that concerns were sent to department heads and responses were supposed to be reviewed at subsequent meetings, but the process did not always result in clear or documented outcomes. The Administrator acknowledged that many concerns were handled verbally and that there was no evidence of resolutions for certain issues, such as missing clothing or items removed from rooms. He also could not explain the lack of response to MD/NP concerns and admitted that the facility needed to be clearer and more specific in their responses. The lack of thorough documentation and follow-up led to residents feeling their concerns were not being addressed, as evidenced by both the meeting records and resident interviews.