complaint·February 5, 2025

interviews at 02:00PM, 02:14PM and 02:42PM. LPA reviewed and obtained copies of documents relevant to the investigation, including the police report related to the incident that occurred on 12/07/2024. The following was then determined: On 12/07/2024 in the early afternoon hours, there was an altercation between R1 and R2 on the outdoor patio of R1’s room. Neither resident could recall what started the altercation, but both were aware of the physical altercation that resulted. The residents indicated they were friends and would spend time in R1’s room often. On the date of the incident, R2 had gone to R1’s room and they were both out on the patio of R1’s room when a verbal altercation escalated into a physical altercation. Review of documents for both R1 and R2 revealed that both residents are independent, with the exception of both requiring assistance with medication management. Neither resident requires 1:1 supervision and both residents are able to leave the facility unassisted, according to their physician’s reports. Staff interviewed indicated that R1 tended to remain in their own private room most of the time, but that R2 would visit R1 from time to time. Staff stated that residents are free to move about the facility as they wish and it is common for residents to visit with other residents in their private rooms. On the date of the incident, the Maintenance Director heard yelling, looked outside and down towards where the sound was coming from and saw R1 and R2 on the outdoor patio of R1’s room. Maintenance Director responded to R1’s room, while calling for care staff and medication technician to respond to the room as well. Medication Technician called 9-1-1. In total, 5 (five) staff responded to assist with the incident. Staff were able to separate the residents and started assessing both residents for injury. Both police and paramedics responded to the facility promptly and assisted both residents before taking both residents from the facility. Staff interviewed stated both residents are back in the facility currently. Following the incident, they now stay away from each other and do not interact. Interviews and documents reviewed do indicate the incident occurred, which resulted in injury to both residents. However, document review revealed that both residents are independent and did not require constant care and supervision. Both residents admitted they chose to enter R1’s private room and engaged in conduct which violated the facility’s documented house rules. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. No deficiencies cited during this visit. Exit interview conducted. A copy of the report was provided.