complaint·October 3, 2025

week on Wednesdays (LPA made the initial complaint visit on a Tuesday). Furthermore, LPA obtained the week’s grocery shopping list which showed a mixture of fresh produce and processed foods. LPA interviewed R2 and R3 who both stated that they enjoyed the food and had no complaints. Allegation: Staff do not ensure food is stored properly at the correct temperatures LPA observed that the refrigerator and freezer had built in thermometers. LPA observed and photographed the refrigerator temperature at 37 degrees and the freezer at 0 degrees. These temperatures are within the required range. Allegation: Staff do not ensure food sanitation practices are followed LPA interviewed staff who stated that they always change their gloves between tasks and residents. No staff interviews acknowledged leaving food out for an extended period of time or witnessing other staff doing so. LPA did not observe any perishable food on the counter during visits. Additionally, LPA observed leftover food in the refrigerator, covered, and dated. Allegation: Staff do not prevent residents’ personal food items from being taken by other people in the facility LPA interviewed staff who stated that R1 would share their food with other residents at the facility. Additionally, there are residents at the facility with cognitive impairment who would not be aware they are eating a resident’s personal food. The food in the kitchen is unlocked, therefore available to all residents. Additionally, no staff acknowledged eating any food belonging to a resident. Allegation: Staff does not ensure residents is spoken to in an appropriate manner LPA interviewed R2 and R3. Neither of the residents had any instances of staff speaking inappropriately to them. Additionally, staff interviewed stated they speak respectfully to all residents. Allegation: Staff does not ensure medications are properly managed LPA reviewed medication administration records (MARs) for each resident. MARs matched current doctors orders. LPA interviewed R2 and R3 who stated that they have not had instances of their medications being mismanaged. Allegation: Staff do not ensure the facility is kept free of pests LPA toured the facility and found no evidence of pests. LPA observed and photographed two sticky traps which showed no evidence of pests. LPA obtained the facility’s contract with a local pest control company which shows the facility receives monthly service. Additionally, LPA interviewed R2 and R3 who had no complaints of pests inside the facility. Staff interviews did not reveal any concerns about pests. Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegations are found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted. A copy of this report was left at the facility.