complaint·November 8, 2025

(Page 2) Report continued from LIC 9099... During today’s visit, starting at 11:50 a.m. LPA conducted the entrance interview and a brief physical plant tour to ensure there are no immediate health and safety concerns, and facility is in compliance with Title 22 Regulations. At 1:00 p.m., an in-person interview was conducted with the RSD. At 2:10 p.m., an in-person interview was conducted with the ED. At 3:13 p.m., a file review was completed for R1. At 3:25 p.m. and 3:27 p.m., attempts were made to conduct two (2) resident interviews with individuals who resided in the community during June 2023. At 3:30 p.m., one (1) in-person interview was conducted with a resident who resided in the community during June 2023. Additionally, two (2) staff interviews were conducted with employees who were employed during June 2023, at 4:00 p.m. a telephonic interview with POA of R1 was attempted and copies of pertinent documents relevant to the investigation were obtained. On the allegation Staff did not provide adequate supervision resulting in resident being assaulted by another resident, it is the concern of the reporting party (RP) that R1 was assaulted on 06/11/2023 by another resident due to lack of supervision. To investigate this complaint, LPA Mosley conducted in person interviews, attempted to conduct a telephonic interview, a file and record review and obtained copies of pertinent documents relevant to the investigation. File review revealed that R1 was admitted to the facility on respite care from 06/11/2023 to 6/18/2023. R1 was on hospice. R1 did not have any documentation or incident reports related to any incidents while at the facility. Record review revealed that there was no incident report for R1 or for the alleged incident date of 06/11/2023. Interview attempts with the POA of R1 were made on 06/23/2023, 7/18/2023, 11/8/2025 and were unsuccessful. Resident interview revealed that during the time frame of June 2023 they felt safe at the facility. There was adequate supervision. They were not assaulted by another resident. They did not witness or hear of another resident being assaulted by another resident. Staff interviews revealed that during the time frame of June of 2023 they do not recall R1. They do not recall any incidents that took place during June of 2023. During June of 2023 they provided adequate supervision and kept the residents safe. It was noted that residents can get agitated and may attempt to strike another resident, however they are trained to step in and redirect the behavior. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation of Staff did not provide adequate supervision resulting in resident being assaulted by another resident is deemed unsubstantiated at this time. Exit interview conducted. Report was reviewed and a copy was provided.