complaint·November 5, 2025

con't from Lic 9099 Staff did not assist resident with toileting needs. Based on LPA Silveira’s observations, bedding, linens, walls and bathrooms were clean. LPA did not observe any stains or fecal matter anywhere in the bedrooms. The bed linens were all clean. On June 21, 2024, ED states, “Two months ago…. R1 is independent and even though R1 needs toileting assistance, R1 will try to go to the bathroom and do things without staff assistance. Staff have found soiled briefs on the floor and in R1’s walker.” A review of R1’s Individual Service Plan (ISP) indicates R1 needs total assist with toileting. Licensee does not ensure sufficient number of staff on site to redirect residents from exiting the memory care unit. On June 21, 2024, LPA Silveira interviewed ED who states that R1 attempted to exit the facility twice: January 28, 2024, and May 26, 2024. And on those occasions, staff were able to redirect R1 and prevented R1 from exiting the facility. RSC states that R1’s exit seeking behavior is being addressed by keeping R1 engaged in activities to help decrease elopement tendencies. At the time of interview, R1 was “put to assist med techs to deliver medications.” Based on records review and interviews conducted, the above allegations are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. No deficiency is noted. A copy of this report was provided to Bonn.