complaint·October 7, 2025

The investigation revealed the following: Allegation: Staff did not prevent residents from smoking in non-smoking areas of the facility. It is alleged that residents have been observed smoking right outside the building in an area with a sign that says no smoking. LPA toured facility and observed patio area near entrance to have No Smoking signs along with an additional sign that say Smoking Allowed Only When it is Raining, LPA also toured the patio area that is enclosed in the facility. During tour LPA did not observe any of the smokers, smoking in non-designated areas. LPA interviewed 3 staff and each denied the allegation, however, they did explain that when it is raining residents are allowed to smoke in the front patio area, as long as the doors are closed. S1 stated this was implemented because the residents needed a covered area for when it rains to still be able to smoke, S1 further stated that last week there was a day that rained and there were a few smokers that used the front patio to smoke their cigarette and followed the rules. LPA interviewed 8 residents and 7 out of 8 residents denied the allegation, 6 residents stated that although some residents will break the rules and smoke in non-designated areas, staff will go out and remind them of the smoking rules and guide them to the smoking areas. Allegation: Licensee did not ensure facility cleanliness was maintained. It is alleged that the carpets, furniture, and lobby areas are dirty. LPA toured facility and observed the housekeepers doing rounds, they were mopping and cleaning rooms and hallways. LPA did not observe any carpets during the visit, minus the front entrance carpet in the lobby that is used to dust off shoes when you enter the facility. Floors throughout the facility appeared clean and non-sticky, and there were no foul odors observed. LPA interviewed 3 staff and each denied the above allegation, each stated that housekeeping clean throughout the day and feel the facility is being well maintained in that aspect. LPA interviewed 8 residents and each denied the above allegation stating that the housekeepers mop/sweep/take out trash on a daily basis, sometimes 2-3 times a day. Based on statements and interviews conducted with staff/residents, tour of facility and LPA observations, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.