Complaint Investigation Report

Regarding the allegation: Staff did not prevent a physical altercation between residents in care. It is being alleged that two (2) residents were involved in a fight in the dining hall and there was no staff present. During LPA's interview with Resident #1 (R1), R1 was asked what happened and R1 stated, "I don't remember anything." LPA asked were any staff present and R1 stated, "no." During LPA's interview with Resident #2 (R2), R2 stated, "they did not remember what happened that day." LPA asked R2 if there was any staff present during the incident and R2 stated, "no." LPA interviewed two (2) staff that were present the day of the fight and they confirmed that there were no staff present during the fight in the dining hall. Staff #1 (S1) confirmed that while they were passing by they heard a loud noise and when they looked over R1 was already on the floor. Staff #2 (S2) confirmed they responded to give R1 and R2 medical attention if they needed any but the fight had already occurred when they went to the dining hall so they did not observe anything. S2 also remembers there was no other staff present because it was a weekend day. LPA confirmed that the incident was a Sunday-12/14/25. LPA interviewed fourteen (14) other residents and out of the fourteen (14) residents two (2) remember the incident involving R1 and R2. Both residents that were present for the fight stated, "R2 pushed R1, R1 then fell hitting their head and when R1 got up they went towards R2 with a butter knife." LPA asked the two (2) residents that remember the incident if there were any staff present and they both stated, "no." The twelve (12) other residents that were interviewed did not recall the incident between R1 and R2. Therefore, based on the staff and resident interviews, the above allegation(s) above is SUBSTANTIATED at this time.

An exit interview was conducted, citation(s) were issued, an appeals right was provided and a copy of this report was given to the Administrator.