Complaint Investigation Report

Resident fell while in care due to staff neglect.

Staff did not respond to resident's requests for assistance in a timely manner.

Staff are not feeding resident food according to their special diet/restrictions.

The complaint alleges the following: On Sunday before Memorial Day, R1 fell off of the toilet because staff took too long to respond to R1’s call for assistance, R1 pulled the emergency “lever” [call button], but staff didn’t respond for two hours, the facility does not adhere to R1’s dietary preferences/restrictions and the facility did not refill R1’s medication when it ran out.

On 6/13/25 between 8:42am-10:00am LPA conducted interviews with Deeyanna Banda, Memory Care Director (A1), and Brittany Kavanaugh Executive Director (S1) who denied the allegations stating that R1 is not a resident of the facility and has never been a resident of the facility. Additionally, LPA interviewed S2-S3 regarding the allegations and they also denied the allegations stating that R1 is not a resident of the facility.

On 6/13/25, LPA obtained/reviewed staff rosters dated (1/1/25-6/13/25) and R1's name was not listed on either roster which corroborated staff's report that R1 is not nor has been a resident of the facility.

This agency has investigated the complaint alleging: Resident fell while in care due to staff neglect; Staff did not respond to resident's requests for assistance in a timely manner; Staff are not feeding resident food according to their special diet/restrictions; and Staff mismanage resident's medications.