complaint·July 21, 2023

Continued from LIC9099 Resident interview revealed that R1 was not able to confirm the exact timeframe the event occurred, but the details of the incident and description of the alleged perpetrator remained consistent. R1 informed that they did not notify staff for help or make known that the event occurred until days later. Resident interview revealed that the incident was isolated and has not happened at any other time. Outside source interview revealed that a private caregiver for an unrelated resident was present at every mealtime during the timeframe of the complaint, and no incidents were observed regarding any resident altercation. Outside source interview revealed that facility staff have been observed to be attentive and caring to residents' needs. No outside sources revealed concerns regarding staffing issues and/or lack of supervision during the timeframe of complaint. Records review revealed that facility management conducted an internal investigation regarding the incident, which did not result in plausibility that the event could have occurred, or that lack of supervision existed during the timeframe of complaint. During two unannounced facility visits, LPA directly observed the location of the incident in question. LPA observed that from almost all locations in the space, the alleged event would have been seen by the staff and/or private caregiver based on the noted locations of people in the room and the number of staff present during that time. LPA observed staff tending to residents and assisting them with Activities of Daily Living (ADLs) and group activities. LPA did not observe a situation where a resident was left unattended or in need of help without staff presence. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Maria Flores, Marketing Manager, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.