Failure to Document and Resolve Resident Grievances
Penalty
Summary
The facility failed to maintain documentation of resolved grievances and evidence of the results of all grievances for multiple residents and over several months. Specifically, there was no documentation of resolved grievances for two residents who were not cognitively intact, despite their responsible parties reporting concerns about delays in incontinent care and submitting grievances to staff. The responsible parties did not receive any communication or written response from the facility regarding their grievances. Additionally, the facility's grievance log showed no entries for a six-month period, and the required documentation as outlined in the facility's grievance policy was not maintained. Interviews with staff revealed that the previous Social Worker was responsible for handling paper grievances and distributing them to department heads, but after the transition to a new computer system, there was confusion about who was responsible for managing grievances. The Social Worker left the facility, and no one was assigned to the role during the survey. The administrator confirmed that grievances from the specified period could not be located, and there was a lack of clarity regarding grievance management and documentation during the transition period.