complaint·January 27, 2026

Cont. from LIC 9099-C Therefore, to verify if facility had appropriate coverage for staff shortages during night shift, LPA requested a revised staff schedule for the month of June and July 2025 to determine appropriate staff coverage. On 11/04/25 between 11:30a.m. – 3:45p.m., LPA interviewed additional three (03) residents and on 01/06/26 LPA interviewed three (03) more residents via -phone. Prior to this visit on 12/20/25, LPA Alvizar-Ettima reviewed the documentation previously obtained from the facility Insufficient staffing to meet resident needs It was alleged that there are insufficient staff members to provide for care and supervision for all residents residing in the facility. There are only two (02) night shift caregivers for the entire facility. During mealtime in the dining room, residents’ food is served by the caregivers instead of kitchen staff. Interview with Executive Director revealed that for night shift there are always no less than two (02) staff and no more than three (03) staff working. Plus, five (05) evening shift staff may work double shifts to cover shortage of night shift staff. Executive Director also stated that caregivers are trained in Dining Room procedures and permitted to assist with meal service as part of their job duties. Four (04) facility staff (S1-S4) interviewed during investigation, confirmed the information provided by Executive Director. Staff confirmed that evening shift staff work double shifts to assist night shift if needed. As a part of their job duties, caregivers also assist residents in the dining room. Meal service duties are not compromising resident supervision or care. Residents did not address any concerns regarding staff shortages. During facility visits, residents were observed to be appropriately supervised, and staff were present and engaged in resident care activities. LPA observed caregivers present in resident areas, responsive to resident requests, and assisting them as needed. A review of documents provided by Executive Director verified the information revealed from staff interviews. No information or evidence was obtained to corroborate with the allegation. Based on observation, interviews and records review there is an insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.