complaint·July 7, 2025

On 6/14/2024, LPA interviewed Executive Director (ED) Shantela Yadao. ED stated on 6/4/2024 early morning, he/she received a notice from staff regarding the incident between residents R1 and R2. ED stated based on the review of the surveillance camera footage, on 6/4/2024, around 7:30AM, residents R1 and R2 were walking at the hallway of the memory care unit and R1 blocked R2. R2 tried to walk around but R1 grabbed R2. R2 pushed R1 away and R1 fell on the ground. ED stated staff helped R1 to get up and called 911, and. R1 was sent to hospital. ED stated R2 is not an aggressive person. ED stated this is first incident between R1 and R2. On 6/14/2024, 12/23/2024 and 12/27/2024, LPA interviewed Director of Memory Care (DMC). DMC stated an incident occurred on 6/4/2024 early morning, after breakfast, between residents R1 and R2 at the hallway of memory care unit. DMC stated R1 grabbed R2 and R2 pushed R1 away. R1 fell on the ground, 911 was called and R1 was sent to hospital. DMC stated R1 returned to the facility from hospital on the same day. DMC stated after the incident, the facility requested both R1 and R2's families to hire private companion for R1 and R2. DMC stated R2 is a friendly person and not aggressive. On 6/14/2024 and 12/27/2024, LPA interviewed staff S1. S1 stated the incident occurred on 6/4/2025, early morning, after breakfast. S1 stated he/she was busy helping residents in memory care unit and all the staff in memory care unit were helping residents to be ready to transferred from memory care unit to activity room. S1 stated all residents were waiting to transfer to activity room. S1 stated he/She heard radio announced that a resident fell on the floor of the hallway in the memory care unit and asked staff to help immediately S1 stated he/she went to on site to help resident R1 immediately and called LVN and 911. S1 stated R1 was sent to hospital immediately. On 12/27/2024, LPA interviewed Director of Resident Service (DRS). DRS stated on 6/4/2024, around 7:30AM, staff were busy helping memory care resident to move to activity room, and resident were waiting to transfer to activity room. DRS stated resident R1 and R2 were walking in the hallway of the memory care unit. DRS stated suddenly R1 grabbed R2 when R1 and R2 passed each other. R2 pushed R1 away and R1 fell. DRS stated staff called 911 and R1 was sent to hospital. Continue on LIC9099-C. Page 2 of 3. Based on the review of the Law Enforcement Task Force Report dated 6/7/2024, on 6/4/2025, an incident occurred at the facility and caused resident R1 to obtain bodily injury and was sent to hospital. The incident was captured on video. Based on the footage of the camera system, on 6/4/2024, at 7:28AM, residents R1 and R2 were walking in the hallway of memory care unit and was trying to pass each other. At 7:29AM, R1 reached to R2 and R2 pushed R1 away and down on the ground in the hallway. At 7:30AM, R1 got back up and a staff was attending to R1. R1's injuries were determined to be non life threatening. A safe plan for R1 was put in place by the facility. Based on the review of R2's physician report dated 4/12/2023, R2 has no aggressive behavior. Based on the interview with staff, this is the first incident between R1 and R2, staff stated R2 is not aggressive. Based on the interview and record received, this is the first incident between resident R1 and R2. The incident occurred in suddenly when R1 and R2 tried to pass each other in the hallway of memory care unit and there were 4 caregivers at memory unit helping residents to be ready to transfer to activity room. The facility staff were monitoring through surveillance camera and the announced immediately to have staff to arrive to help R1. Staff arrived on site to help R1 within one minute to help resident. Based on the investigation, interview, records reviewed, the Department found that the above allegation is UNSUBSTANTIATED . An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur. Citations were noted today. Exit interview was conducted with ED. The report was provided to ED for review and signature. A copy of the report was provide to ED. Page 3 of 3.