Complaint·October 7, 2025

Regarding allegation: Facility is charging residents for services not rendered. It is alleged that the facility is charging a resident for services that are not needed. Staff did not inform the residents’ responsible party of the additional monthly fees and staff did not obtain consent for the additional fees from the residents’ responsible party. The additional monthly fees are not listed in the residents’ admission agreement. The investigation revealed that, based on Resident 1 (R1) physician’s report dated 08/21/2024, R1 is self-responsible, able to follow instructions, and able to manage own cash resources. The investigations revealed that seven (7) out of eight (8) residents denied the allegation. Residents did not know of a resident who is being charged for services not received. LPA interviewed R1 and introduced himself at start of interview, but towards the end of interview, LPA had to re-introduce himself after R1 asked who LPA was. R1 was unable to answer questions from LPA and R1 directed LPA to speak with R1’s family. Interview with R1’s family member revealed that R1’s family member identified themselves as R1’s responsible party. R1’s family member learned of the additional fee for R1 in April 2025 when Director Ms. Lyon provided R1’s family member a bill for unpaid fees. R1’s family member reported that R1 doesn’t need additional care, and R1 is not receiving service that R1 is being charged. Five (5) out of eight (8) staff denied knowing or being involved in the decision and process to determine resident rate increases. One staff member stated to be aware of rate increase for R1 but staff is not involved in the process to increase rates for residents. Two staff described the process to re-assess R1 medical condition which resulted in a rate increase for additional services. After an incident where R1 eloped from the facility on 09/01/2024, the facility reassessed R1. On 09/01/2024, the facility identified R1’s risk of eloping which resulted in staff providing additional service to prevent R1 from eloping from the facility. Due to change of condition, R1 agreed to wear the monitor bracelet and signed the rate increases form with the effective date of 09/01/2024. The facility added services to R1, which consisted of frequent wellness check and monitoring bracelet to alert staff when R1 is attempting to exit the facility. The facility informed R1’s family member on 09/03/2024 via email of fee increase. Additionally, the facility staff contacted R1’s primary doctor who requested R1 to visit the physician’s office. Based upon the investigation, resident and staff interviews, document review, and LPA observations, R1 is receiving the services as identified by R1’s re-assessment to prevent R1 from eloping from the facility. R1 is self-responsible, and R1 does not have a responsible party. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview held with Director of Health Services Milca Osorio. A copy of the report was provided.