Failure to Timely Investigate and Resolve Resident Grievances
Penalty
Summary
The facility failed to investigate and resolve resident grievances in a timely manner for multiple residents, as evidenced by interviews, record reviews, and policy review. Residents repeatedly raised concerns about excessive noise at night, particularly from staff activities and roommate televisions, during several resident council meetings. Despite these ongoing complaints, residents reported that no resolution had been communicated to them, and the noise disturbances persisted. The facility's grievance log did not reflect timely documentation or follow-up on these issues, and some grievances were not logged until months after the initial complaint. Several residents with varying cognitive abilities, including those with moderate impairment and those who were cognitively intact, described being disturbed at night by staff entering rooms, knocking loudly, turning on lights, and offering services such as ice water or trash removal during early morning hours. Residents also reported that staff responses to their complaints were inadequate, with some staff members being described as rude or dismissive. In cases where residents complained about roommate behavior, such as loud televisions, staff acknowledged the issue but did not provide a timely or effective resolution, and the facility lacked a clear policy regarding television use at night. Additionally, the facility did not complete or document grievances related to allegations of verbal abuse by staff, as identified during a facility-reported incident investigation. Residents reported instances of staff yelling, using negative language, and making inappropriate comments, but these grievances were not entered into the grievance log or investigated according to facility policy. Interviews with the Social Services Director and Administrator confirmed that some grievances had not been completed or addressed, and there was a lack of consistent follow-up and communication with residents regarding the outcomes of their complaints.