complaint·October 9, 2024

As a result, LPA observed for facility staff to be utilizing a red and black band that was adjusted with a silver clamp to hold the band in place that would assist with keeping the gate closed. Per interview with the Business Office Manager the facility was in the process of getting quotes to repair the gate. LPA requested copies of the quotes but were not received. LPA followed up on 07/16/24 in regards to the status of the gate repair, and was informed that the facility was still in the process of obtaining quotes. On 09/30/24 LPA conducted a follow up visit and observed for the gate to have been repaired and the code entry mechanism to be functioning properly. Based on observation and interviews the allegation of staff did not ensure the facility was in good repair is substantiated. Staff did not provide a safe environment. It was alleged that a door in memory care was not functioning properly (locking) as the locked door was to assist with preventing memory care residents from leaving out of the designated areas, and the electronic function was not working on the door. LPA observed for said door to be working properly at the time that the visit was conducted on 07/12/24. However, through further investigation of a conducted records review revealed that on 06/27/24 Resident #1 (R1) was able to successfully exit out of the facility. Local law enforcement had to respond to the facility and was able to successfully locate R1 in another building. R1 was said to have entered into the bedroom of another resident and walked out onto their patio, walked down the pathway and exit through the gate that was disarmed and not functioning/locking properly. Per an interview with Memory Care Director Jenna Lazaga R1 did not obtain any injuries and as a result the eloping incident the facility implemented two-hour safety checks. Based on interviews and records review the allegation of staff did not provide a safe environment is substantiated. An allegation that is substantiated means a finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted and a copy of this report, appeal rights, LIC811-confidential names list and LIC9098-Proof of corrections form was reviewed and provided to Executive Director Jennifer Gephart.