Complaint·April 10, 2026

Finding: Staff Did Not Seek Medical Attention for a Resident in Care – Unsubstantiated Program Analyst (LPA) interviewed four (4) staff members, all of whom stated that medical attention is sought promptly whenever a resident is injured, becomes ill, or expresses a need for medical care. Additionally, five (5) resident interviews indicated that staff do seek medical attention when needed. An interview with the complainant further confirmed that the facility did, in fact, seek medical attention for Resident 1 (R1) while in care. Finding: Staff did not prevent a resident in care from sustaining falls – Unsubstantiated Licensing Program Analyst (LPA) interviewed four (4) staff members, all of whom stated that residents identified as fall risks are provided with appropriate supervision and assistance in accordance with their care plans. Staff reported that preventative measures, including monitoring, reminders, and assistance with ambulation, are implemented to reduce the risk of falls. LPA also interviewed five (5) residents, who indicated that staff are available to assist when needed. Residents reported that staff respond to requests for help and provide support with mobility and daily activities. In addition, LPA reviewed relevant facility records, including but not limited to incident reports, care plans, and physicians’ reports. Documentation reviewed did not indicate that staff failed to implement appropriate fall prevention measures or that neglect contributed to resident falls. Report Continue on LIC9099C1... Finding: Staff did not allow a resident to receive phone calls- Unsubstantiated Licensing Program Analyst (LPA) interviewed four (4) staff members, all of whom stated that residents are permitted to receive phone calls. Staff reported that Resident 1 (R1) has, at times, refused to accept phone calls. LPA also interviewed five (5) residents, who indicated that they are allowed to receive phone calls and that staff do not restrict access. Residents further reported that R1 has declined phone calls on occasion. In addition, LPA reviewed relevant documentation, including court records. LPA observed a court order granting R1’s conservator the authority to deny and/or limit visitation and communication, including phone calls. Finding: Staff are not bathing a resident in care- Unsubstantiated Licensing Program Analyst (LPA) interviewed four (4) staff members, all of whom stated that residents are assisted with bathing in accordance with their needs and established shower schedules. Staff reported that assistance is provided twice a week or as required and that residents are encouraged to maintain personal hygiene. LPA also interviewed five (5) residents, who indicated that staff assists with bathing and that they can shower regularly. Some residents reported that they choose their preferred bathing times or occasionally decline assistance. In addition, LPA reviewed facility documentation, including shower schedules, which indicate that bathing assistance is scheduled and provided to residents as needed. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore these allegations are UNSUBSTANTIATED . No deficiencies are being cited on this date. Exit interview conducted. A copy of this report provided.