Failure to Address Resident Grievance Regarding Nursing Care
Penalty
Summary
The facility failed to ensure that a resident's grievance regarding the care provided by an LVN was properly addressed according to its grievance policy. A resident with multiple complex medical conditions, including dementia, chronic kidney disease, pressure ulcer, and other comorbidities, had a family member who verbally reported concerns about neglect and dissatisfaction with the care provided by an LVN. The family member specifically requested that the LVN not provide care to her family member and expressed concerns that the LVN was responsible for the resident's wound and decline, alleging that dressing changes were not performed as ordered. Despite these concerns being reported to both the Marketer and the Administrator, no grievance form was completed, and no investigation was initiated by the facility. The Administrator stated she was unsure of the grievance policy and did not act because the family member mentioned contacting the State. The DON did not recall being informed of the concerns and did not believe the comments warranted an investigation. The facility's policy required that grievances be documented and investigated immediately, with written decisions provided if requested, but this process was not followed in this instance. Interviews with staff confirmed that the family member's concerns were communicated to facility leadership, but there was a lack of follow-through in initiating the grievance process. The facility's failure to document and investigate the grievance as required by policy resulted in the resident's complaint not being formally addressed, potentially leaving the concern unresolved.