complaint·October 29, 2025

R1’s Physician’s Report, dated 1/17/2024, stated that R1 was non-ambulatory based on mental condition, but that R1 could transfer independently to and from bed. Community Care Licensing Division (CCLD) personnel interviewed R1’s Responsible Party. The Responsible Party stated that R1 walked without assistance before moving to the facility in Spring 2025 and used a walker provided by staff after moving in. CCLD personnel interviewed four facility staff. Staff stated that R1 was able to walk unassisted with a walker and transfer from bed to the walker independently. Staff and R1’s Responsible Party stated that when R1 returned to the facility after the 7/31/2025 fall, R1 continued to be able to walk unassisted with a walker. Staff stated that there was no lack of supervision. Staff frequently saw R1 enjoying walking around the facility and observed R1 every two hours during rounds and approximately every thirty minutes during informal checks. Based on interviews, observations, and record review, the above allegation is UNSUBSTANTIATED, which means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.