Complaint·May 8, 2026

Continue on LIC9099... During the course of this investigation, LPA conducted 10-day visit, made observations, reviewed records, interviews with staff and residents in care. During LPA’s visit, LPA conducted a tour of the facility and observed three caregivers and one med-tech. Based on records review, LPA was provided with LIC 500 personnel report and staff schedules for Memory Care Unit for the months of March and April 2026 with a census of 27 residents in care which are divided into three groups with an average of six residents per group. Per staff schedules indicate that the facility had an average of one assigned caregiver on duty for a group of six residents in care and one med-technician who alternates covering the floor when they are not passing medications Also, there was additional staffing including cooker, server and housekeeping personnel, but they do not provide caregiving assistance to residents in care. Furthermore, the alarm response report dated March 01, 2026, 12:00am through April 14, 2026, 9:30am did not provide any supportive evidence regarding delays in staff response times to assist residents in care. According to administrator most of the residents are not aware of the call alert system due to cognitive challenges and it was clarified that current residents are residing at the memory care unit, but it was disclosed that the building is divided into two wings (East and West), where residents are located depending on their current care needs. Based on interviews conducted with residents (R1 & R2) and staff (S1, S2, S3, S4, S5 & S6) revealed conflicting information, resulting in LPA was unable to find any supporting evidence due to the very limited information obtained from interviews with residents and staff who indicated they could benefit by having additional staffing, because at times it gets busy between both wings, and they are suggesting to management to perform a better assessment of current residents’ care needs based on risk of elopement and behaviors, because there are more residents that have not been identified as needing two people assistance to manage their behaviors safely. However, staff recognized that the use of surveillance cameras in common areas that are monitored by the receptionist is helping to reduce elopement incidents. A finding that the complaint allegation occurs of facility does not have adequate staff to meet residents’ care needs is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.