complaint·October 9, 2025

CONTINUED FROM FORM LIC9099-A Resident R1 was admitted to the facility on October 3, 2020 and assessed as the time as diagnosed with multiple comorbidities such as: " dementia, [stage III] chronic kidney disease, obstructive sleep apnea, hypothyroidism, atherosclerotic aorta, atria fibrillation, hypertension, [congestive heart failure] " as well as a pacemaker implanted. R1's condition is well documented in both their physician report and individual needs assessment established upon admission. Per an incident report submitted on May 4, 2021, R1 was admitted to the hospital after sustaining a low oxygen saturation episode in spite of being provided oxygen as prescribed. Regarding the allegation that Staff did not seek medical attention to resident in a timely manner , the following has been concluded: Based on staff interviews and incident reports submitted in May and July 2021, staff were trained to regularly check R1's oxygen saturation levels and reacted accordingly if concerning vitals were measured. As R1 sustained a health emergency on July 3, 2021, paramedics were called by a family member who was visiting at the time. There is however insufficient information corroborating that staff would have been untimely in requesting medical assistance if that had not been the case. As a result, the allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred. An exit interview was conducted and a copy of this report was provided to a facility representative. CONTINUED FROM FORM LIC9099 Resident R1 was admitted to the facility on October 3, 2020 and assessed at the time as diagnosed with multiple comorbidities such as: " dementia, [stage III] chronic kidney disease, obstructive sleep apnea, hypothyroidism, atherosclerotic aorta, atria fibrillation, hypertension, [congestive heart failure] " as well as a pacemaker implanted. R1's condition is well documented in both their physician report and individual needs assessment established upon admission. Per an incident report submitted on May 4, 2021, R1 was admitted to the hospital after sustaining a low oxygen saturation episode in spite of being provided oxygen as prescribed. Upon readmission after being discharged from a skilled nursing facility, R1 was reassessed on May 26, 2021. A written statement by R1's responsible party and attorney-in-fact confirms that R1's condition at the time of their passing was consistent with the documented condition on file as well as with earlier communication with facility staff via text, telephone and/or verbal exchanges. As a result, the allegation that Staff did not notify authorized representative about change of resident health condition is determined to be Unfounded , meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted and a copy of this report and the list of Confidential names LIC811 were provided to the facility.