complaint·January 29, 2026

The investigation revealed the following: Allegation #1- Staff engaged in inappropriate interactions in the presence of residents in care. The details of the complaint alleged that the facility staff are engaging in inappropriate activities in the facility. It was reported that a resident witnessed staff having sex with another staff member in the kitchen in the middle of the night. On 1/29/2026, from 9:30am-2:00pm, the department interviewed staff (S1-S4) regarding the allegation. 4 of 4 staff denied the allegation that Staff engaged in inappropriate interactions in the presence of residents in care. All staff stated that they have never witnessed, been a part of, or heard of any staff member having sexual relations in the facility. They also stated that no staff has ever engaged in any inappropriate interactions in the presence of other residents. The department interviewed residents (R1-R3) about the allegation and 2 of 3 residents that were interviewed stated that they have not witnessed any staff member having sex with each other in the facility or saw any staff member engaging in any inappropriate activities. Based on interviews, there is insufficient evidence to support the allegation that Staff engaged in inappropriate interactions in the presence of residents in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated . Allegation #2- Staff stole money from residents in care. The details of the complaint alleged that the facility staff are stealing money from residents. It was reported that the facility staff are borrowing money from residents and stealing money out of their rooms. On 1/29/2026, from 9:30am-2:00pm, the department interviewed staff (S1-S4) regarding the allegation. 4 of 4 staff denied the allegation that Staff stole money from residents in care. All staff stated that they have not borrowed any money from any of the residents in the facility. Nor have they witnessed or heard of any other staff member stealing from the residents. The department interviewed residents (R1-R3) about the allegation and 2 of 3 residents that were interviewed stated that they have not witnessed any staff member stealing from them or other residents. 2 of 3 residents that were interviewed also stated that they have never loaned any money to staff nor have they asked to borrow money from them. The department reviewed the Resident Personal Property and Valuables List (No Date) and the Record of Clients/Residents Safeguarded Cash Resources (Dated: No Date) and did not observe any discrepancies. Resident R1 does not receive a P & I fund, and the personal items list was clothing related. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that Staff stole money from residents in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated . Report Continued on LIC9099-C Allegation #3- Staff left residents in soiled bedding for an extended period of time. The details of the complaint alleged that the facility staff left residents in soiled bedding for an extended period of time. It was reported that staff allow residents to lay in feces all day without changing them into clean briefs. On 1/29/2026, from 9:30am-2:00pm, the department interviewed staff (S1-S4) regarding the allegation. 4 of 4 staff denied the allegation that Staff left residents in soiled bedding for an extended period of time. All staff stated that they have not witnessed or allowed any resident to remain in soiled bedding or soiled briefs for an extended period of time. They state that four residents are independent and do not need assistance with incontinence issues. While two other residents are on hospice and are changed or checked on three times per day and are changed as needed to make sure, they are dry. The department interviewed residents (R1-R3) about the allegation and 2 of 3 residents that were interviewed stated that they have not witnessed any resident who were left in soiled bedding or soiled briefs. The department took a tour of the facility and the residents room and did not observe or smell any issues with incontinence. Based on interviews and observations, there is insufficient evidence to support the allegation that Staff left residents in soiled bedding for an extended period of time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated . Allegation #4- Staff did not provide adequate meals for residents in care. The details of the complaint alleged that the facility staff do not provide adequate meals for the residents. It was reported that staff are serving cold food and are not providing water or fruit for the residents. On 1/29/2026, from 9:30am-2:00pm, the department interviewed staff (S1-S4) regarding the allegation. 4 of 4 staff denied the allegation that Staff did not provide adequate meals for residents in care. All staff stated that the residents get three nutritious meals per day along with fruit, snacks, and fluids and are not deprived of anything. They also state that the facility has a water dispenser in the kitchen that is readily available to anyone who wants or needs water. The department interviewed residents (R1-R3) about the allegation and 2 of 3 residents that were interviewed stated that they get nutritious hot meals, fruit, water, juice, and snacks throughout the day. They also state that they are satisfied with the care and supervision provided by the staff. The department reviewed and observed the facility’s menu and observed that the residents are given a balanced diet that includes meat, poultry, vegetables, fish, grains, eggs, milk, cheese, and fruit. The department also observed the cook making a hot meal for the residents upon arrival for the investigation. Report Continued on LIC9099-C Based on observations, interviews and records reviewed, there is insufficient evidence to support the allegation that Staff did not provide adequate meals for residents in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated . Allegation #5- Staff sleep at the facility while on shift. The details of the complaint alleged that the facility staff sleep while they are on shift. It was reported that the staff are sleeping on the job when they should be taking care of the residents. On 1/29/2026, from 9:30am-2:00pm, the department interviewed staff (S1-S4) regarding the allegation. 4 of 4 staff denied the allegation that Staff sleep at the facility while on shift. All staff stated that they have never slept or witnessed any other staff member sleeping on the job when they should be working. They also stated that staff do take breaks and sit on the couch in the kitchen, but they never sleep in the facility. The department interviewed residents (R1-R3) about the allegation and 2 of 3 residents that were interviewed stated that they have not witnessed any of the staff sleeping on the job when they should be working. 2 of 3 residents that were interviewed also stated that there is always someone available when the need assistance. Based on interviews, there is insufficient evidence to support the allegation that Staff sleep at the facility while on shift. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated . Allegation #6- Staff contaminated the food served to resident in care. The details of the complaint alleged that the facility staff are contaminating food in the facility. It was reported that staff are serving food to the residents with hair in their food. On 1/29/2026, from 9:30am-2:00pm, the department interviewed staff (S1-S4) regarding the allegation. 4 of 4 staff denied the allegation that Staff contaminated the food served to resident in care. All staff stated that both cooks are sanitary and wear gloves when preparing meals and have never served any contaminated food to the residents. They also state that no one has reported or verified that they have received a meal that had hair in it. The department interviewed residents (R1-R3) about the allegation and 2 of 3 residents that were interviewed stated that they have not received any meal that was contaminated or had hair in it. They state that they are satisfied with the meals served by the staff. Based on interviews, there is insufficient evidence to support the allegation that Staff contaminated the food served to resident in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated . Report Continued on LIC9099-C Allegation #7- Staff did not bathe residents in care. The details of the complaint alleged that the facility staff are not bathing the residents in care. It was reported that staff allow the residents to lay in bed for extended periods of time without bathing them. On 1/29/2026, from 9:30am-2:00pm, the department interviewed staff (S1-S4) regarding the allegation. 4 of 4 staff denied the allegation that Staff did not bathe residents in care. All staff stated that four of their residents are independent and do not need assistance with showering or bathing. While two other residents are on hospice and are bathed twice a week by the hospice nurse, and at other times they are given sponge baths by the staff. The department interviewed residents (R1-R3) about the allegation and 3 of 3 residents that were interviewed stated that they have not had any issues with bathing because they are independent and can bathe and shower themselves. They also state that they have no knowledge of anyone being deprived of having a bath or shower. Based on interviews, there is insufficient evidence to support the allegation that Staff did not bathe residents in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated . No citations were issued. An exit interview was conducted with Evangeline Agatep, Administrator, and a hard copy of this Complaint Investigation Report was provided.