Failure to Document and Communicate Responses to Resident Council Concerns
Penalty
Summary
The facility failed to adequately communicate and document its responses and rationales to concerns raised during Resident Council meetings for five out of ten meetings reviewed. Resident Council minutes from several months indicated that residents repeatedly voiced concerns regarding food variety, menu postings, consistency of dietary staff, and issues with nurse aides not making beds or turning off lights after care. Despite these ongoing concerns, the minutes lacked documentation of the facility's responses, actions taken, or rationales for addressing or not addressing the issues raised. Interviews with residents confirmed that they rarely received communication from facility staff regarding what was done to address their concerns voiced during meetings. Residents expressed a desire for more transparency and involvement in the resolution process. The Activity Director, who had recently assumed her role, acknowledged that while she shared concerns with the Administrator and department managers, she did not document these concerns on grievance forms nor consistently provide written resolutions to the Resident Council. Instead, resolutions were often communicated verbally to individual residents, if at all. The Administrator confirmed that concerns raised during Resident Council meetings were assigned to department managers for investigation and written response, but was unable to provide documentation of such investigations or resolutions since his employment began. The facility's grievance logs did not reflect any concerns filed on behalf of the Resident Council during the review period, further indicating a lack of formal documentation and follow-up regarding resident concerns.