Complaint Investigation Report

The Administrator acknowledged the fall occurred and stated that after reviewing video footage on 10/30/25, R1’s responsible party was notified and 911 was called. Two (2) staff interviewed informed LPAs they had not seen any signature forging and stated that when incidents occur, they call 911, notify the Administrator, and record detailed notes in the log. The log does not require staff signatu res. LPAs reviewed facility’s incident log and confirmed that staff signatures are not required. Additionally, review of an incident report (submitted to CCLD on 11/03/25) showed only the Administrator’s typed name in both signature sections - no signatures from any staff were observed. Therefore, based on interviews and document review this allegation is deemed Unsubstantiated at this time.

No deficiency issued during today's visit.

Exit interview conducted and copy of this report signed and delivered.