complaint·December 19, 2025

LPA was unable to interview one (01) resident due to current health condition. During the physical plant tour, LPA did not observe any food trays being left in residents’ rooms. A review of R1’s Hospital Admission Records indicates the R1 has previous infection conditions prior to R1’s most recent hospitalization. The facility’s visitor’s log also indicates that Home Health visited once or twice a week. During interviews with staff, all staff stated Home Health was in the facility once or twice a week and staff were trained on how to change the dressing as needed. Staff added that R1 came to the facility with infections and that if anything, the facility healed R1 and made R1 better. During interviews with residents, all interviewed residents stated they feel confident staff would follow doctor’s orders and assist in getting the necessary care they need. Based on observations, record review and interviews, there is not enough information to verify the allegation. Therefore, the allegation is unsubstantiated at this time. --- Staff do not follow proper food safety protocols. It was alleged that when R1 doesn’t eat lunch, the same meal is reheated and served for dinner. To investigate the allegation, on 06/04/2025 at around 10:10a.m., LPA Antonia Alvizar- Ettima requested documents, conducted a physical plant tour and at around 12:00p.m., interviewed two (02) staff. On 10/23/2025, LPA Duguma conducted a physical plant tour at around 10:30a.m., requested documents at around 11:30a.m., interviewed two (02) staff from 12:00p.m. to 1:00p.m. and interviewed five (05) out of six (06) residents from around 1:30p.m. to 3:30p.m. LPA was unable to interview one (01) resident due to current health condition. During the physical plant tour, LPA observed fresh foods being prepared. A review of the facility’s sample menu shows that facility serves a variety of well-balanced meals for breakfast, lunch and dinner. LPA observed at least two days of perishable foods and seven days of non-perishable foods available. During interviews with staff, all staff stated they do not reheat what was served for lunch again for dinner. During interviews with residents, all interviewed residents stated they are pleased with the food and do not feel that facility is serving them leftover foods. Based on observations, record review and interviews, there is not enough information to verify the allegation. Therefore, the allegation is unsubstantiated at this time. (CONT. on LIC9099-C) --- Staff mismanage resident's medications. It was alleged that staff regularly leave medications out on Resident #1’s (R1) bedside in a shared room, which is unsafe and increases the risk of medication mix-ups or misuse. To investigate the allegation, on 06/04/2025 at around 10:10a.m., LPA Antonia Alvizar- Ettima requested documents, conducted a physical plant tour and at around 12:00p.m., interviewed two (02) staff. On 10/23/2025, LPA Duguma conducted a physical plant tour at around 10:30a.m., requested documents at around 11:30a.m., interviewed two (02) staff from 12:00p.m. to 1:00p.m. and interviewed five (05) out of six (06) residents from around 1:30p.m. to 3:30p.m. During the physical plant tour, LPA did not observe any medications left out. LPA was unable to interview one (01) resident due to current health condition. During interviews with staff, all staff stated they do not leave medications out and wait for residents to take their medications. During interviews with residents, all interviewed residents stated facility does not leave medications unattended. Based on interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is unsubstantiated at this time. No health and safety hazards noted during the visit. Exit interview conducted and a copy of the report was issued.