complaint·July 24, 2025

Continued LIC9099-C page 2 Facility Complaint and Grievance Policy (dated 08/23/2024) and Staff In-Service Training (dated 06/18/2024). On 07/24/2025, from 11:00 a.m. to 3:30 p.m., the Department interviewed staff members (S1-S3) and residents (R1-R2) regarding the complaint allegations. The Department also attempted to interview residents (R3-R7); however, they were non-verbal, spoke only limited words, and were unable to respond to any of the questions. Mr. Jakina and LPA Bunker toured the facility Memory Care Unit to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during today's visit. Investigation revealed the following. Allegation: Staff did not put a plan in place to ensure the resident would not be physically attacked by another resident It was alleged that the staff failed to put a plan in place to ensure the resident would not be physically attacked. On 07/24/2025, from 11:00 a.m. to 3:30 p.m., staff #1-3 (S1-S3) were interviewed and stated that the facility does have a dementia care plan in place, which was reviewed by the Department. S1 also confirmed that the facility enforces a zero-tolerance policy for negative behaviors, including physical aggression, and that house rules are in effect. 3 out of 3 staff members stated that residents sign an admission agreement acknowledging that physical aggression towards another resident is not permitted. 3 out of 3 staff members stated this was the first incident of aggressive behavior between the residents involved. 3 out of 3 staff members noted that the facility has a plan in place to ensure the residents are protected from being physically attacked by other residents. 3 out of 3 staff members stated that incidents between residents still may occur and that staff cannot prevent such incidents from happening. S1 stated on 07/21/2025, the facility self-reported the unusual incident report to Community Care Licensing and the Ombudsman office in a timely manner. On the same day, the Department received and reviewed the Unusual Incident Report. On 07/24/2025, from 11:00 a.m. to 3:30 p.m., Interviews were conducted with resident #1-2 (R1-R2), who stated that no physical attack occurred and denied the allegations. Resident #3-7 (R3-R7) were non-verbal, spoke only limited words, and were unable to answer any of the questions. See continued LIC9099-C page 3 Continued LIC9099-C page 3 Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the 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 deemed unsubstantiated. Investigation Revealed the following Allegation: Staff did not intervene during a resident-on-resident attack On 07/24/2025, from 11:00 a.m. to 3:30 p.m., staff #1-3 (S1-S3) were interviewed and stated that on 07/21/2025, there was an altercation between two residents; however, neither resident was injured. The caregivers intervened, and the staff self-reported the incident within a couple of hours to Community Care Licensing and the Ombudsman's office on that same day. The residents' responsible parties were also contacted immediately. The department received an Unusual Incident Report dated 07/21/2025 regarding the complaint allegation. S1-S3 stated that staff are trained and receive ongoing training to help prevent incidents like this from occurring. On 07/24/2025, the Department requested and reviewed the Staff In-Service Training on Preventing, Recognizing, and Reporting Abuse dated 06/18/2024. 3 out of 3 staff members stated that appropriate precautions were taken by staff intervening, separating the residents, and redirecting them. S1-S3 confirmed that this was the resident's first instance of aggressive behavior between the residents involved. On 07/24/2025, from 11:00 a.m. to 3:30 p.m., Interviews were conducted with resident #1-2 (R1-R2), who stated that no physical attack occurred and denied the allegations. Resident #3-7 (R3-R7) were non-verbal, spoke only limited words, and were unable to answer any of the questions. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the 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 deemed unsubstantiated. There were no deficiencies cited. A copy of the Complaint Investigation Report LIC9099 and LIC9099-Cs was provided to Robert Jakina, Executive Director. An exit interview conducted