complaint·May 12, 2023

LPA and LPM attained copy of R1’s file (Emergency I.D. sheet, admission agreement, physicians report, DNR letter, consent forms, pre-placement appraisal, needs and service plan, medication list and nurse notes) and obtain a copy of staff and resident rosters. The investigation revealed the following: Allegation: Resident was sexually assaulted while in care. It is being alleged that R1 was sexually assaulted at the facility by an unknown perpetrator. On 02/09/22 Robert Kujawa interviewed administrator (S1) Peggy Clark about the allegations above, S1 denied allegations and reported she was unaware of any resident being sexually assaulted. On 3/30/2022 Robert Kujawa interviewed R1 regarding the allegations above, during the interview R1 denied being sexually assaulted while in care at the facility. On 05/12/23 LPA and LPM interviewed Staff # 2-6, 5 out of 5 staff denied allegation. On 05/12/23 LPA and LPM interviewed residents #2-11, 10 out of 10 residents denied allegations. On 05/12/23 LPA and LPM conducted a review of R1 file, during the review LPA and LPM did not observe any documents to support the allegation. Based on interviews conducted and records reviewed there is insufficient evidence to support allegation. 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. Exit interview conducted to Administrator Peggy Clark and a copy of this report was provided.