complaint·October 24, 2025

Cont. from LIC9099 Prior to this visit on 10/17/2025 LPA Alvizar-Ettima reviewed records and prior documentation obtained during the initial visit. During this visit at 10:10a.m., LPA and Administrator conducted a physical plan tour. Between 10:35a.m. – 12:20p.m., LPA conducted additional interviews with facility staff and three (3) residents. At the time of the investigation, resident #1 (R1) had already passed away. Staff are not allowing residents to pass away in the facility It was alleged that Administrator is not allowing Resident (R1) to pass away in the facility and instead arranges for resident to be transferred to Skilled Nursing Facility (SNF) or other setting at the end of life. Interviews conducted with facility staff revealed that R1 never expressed a desire to pass away in the facility. Administrator indicated that they discussed with R1 the need for higher level of care, and R1 reportedly agreed with the plan for transfer. Staff#1(S1) indicated that R1 had become too weak to transfer independently from bed to restroom. Staff provided continuous care until the last few days, when R1 appeared increasingly weak and immobile. Resident#2 (R2) indicated that staff will temporarily assist residents with mobility. However, all residents must be able to ambulate independently as part of the facility’s admission and retention criteria. A review of R1’s Admission Agreement dated 12/12/2022 confirmed that the agreement included a clause stating that residents requiring medical care and assistance beyond the facility’s capacity must be transferred to a higher level of care. Other residents interviewed during investigation verified that they had knowledge that anyone requiring medical care and assistance beyond the facility’s capacity must be transferred to a higher level of care. Based on interviews and records reviewed, there is not sufficient information to support this allegation. Thus, this allegation is deemed to be UNSUBSTANTIATED at this time. No immediate health and safety issues were noted. Exit interview was conducted and copy of was provided.