Complaint·February 11, 2026

Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced visit to deliver findings regarding the above complaint allegations. The investigation included facility visits, interviews with staff, residents, outside sources, and a review of facility records. On December 09, 2024, the Community Care Licensing Division (CCLD) received a complaint alleging that staff used a full bed rail for Resident #1 (R1) without a waiver or physician’s order and that staff restrained R1. Department records review and Interviews revealed R1 was admited to Hospice on November 8, 2024 and had orders for full bed rails. Documents and interview with OS1 further reveal they observed R1 four (4) times in November 2025 and three(3) times in December and did not observe conserns of restraints either by R1 sitting in chair or while in bed. During LPA’s visit on December 16, 2024, R1 was observed alert and seated in a recliner with no bed rails in use. Based on interviews and records review, a preponderance of evidence did not exist to prove that the alleged violations occurred. Therefore, the allegations were UNSUBSTANTIATED. An exit interview was conducted with LIcensee/Administrator KIngsley Okoro, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.