Complaint·August 13, 2025

LPA obtained and reviewed the resident roster dated 7/16/2025, staff roster, shower schedule for June 30- July 16, 2025, and staff RCA assignment dated 7/11/2025 which is only adjusted when the census changes. The investigation revealed the following: #1 Allegation: Staff physically abused resident At approximately 10:15 AM, the Licensing Program Analyst LPA attempted to interview Resident 1 (R1) on two separate occasions during the investigation; however, R1 was unwilling to participate in an interview. LPA successfully conducted interviews with Residents 2, 3, and 4 (R2, R3, R4), 3 out of the 6 stated they have not experienced any form of abuse by staff members. LPA attempted to interview Residents 5 and 6 (R5, R6), but they were unavailable at the time of the investigation. Residents R2-R4 also permitted LPA to observe their showers, which were equipped with shower heads attached to cords. No health or safety concerns were observed during the inspection. LPA conducted interviews with Staff 1 - 6 (S1–S6). 6 out of 6 staff members stated they have not witnessed or experienced any type of abuse involving residents by any staff member. While S1–S6 acknowledged hearing gossip regarding the allegation of abuse involving R1, therefore they could not confirm if the alleged abuse took place or not. Additionally, 6 out of 6 staff members noted that R1 can sometimes be challenging to assist with Activities of Daily Living (ADLs). In these situations, alternate measures are taken to ensure R1 receives the necessary care, including reassigning another staff member to assist with the residents’ needs. S1 confirmed that R1 had accused them of abuse. In response, S1 stated they immediately reported the allegation to the Administrator, and alternate measures were implemented to ensure R1 received assistance from a different staff member. At approximately 11:30 AM, LPA obtained and reviewed documentation indicating that Staff 1 (S1) attempted to assist Resident 1 (R1) with their ADLs and at the time of the incident the administrator assigned another staff member to assist R1 and implemented an alternate caregiver to prevent future occurrences. Continued Based on the evidence gathered during the interviews, records reviewed, and observations during the investigation, the above allegations are found to be Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and this report was discussed and provided to Luz Rose Administrator at the conclusion of the visit with appeal rights.