Complaint Investigation Report

Interviews were conducted with staff at today's visit and all spoke clearly and all speak English.

All stated there was no language barrier and there is no problem with assisting and communicating with the residents.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

In regards to the allegation Staff are not properly reporting/communicating to authorized representative, based on interviews conducted and information gathered staff revealed that there is an individual calling asking for personal information regarding Resident R1 and stating he is the husband living out of state.

Stated that he is not listed on any documents as an authorized representative.

Also said that he threatened to call the ombudsman and the police.

Administrator said that anytime R1 is discharged this individual will call and was threatening.

Resident R1 was discharged to skilled nursing on 7/7/2025.

Review of file for Resident R1 was conducted and revealed the following:

Admission Agreement signed 8/12/2022 lists for Resident R1 under responsible party Self.

Under Parties to this Agreement it is signed by Resident R1 as resident's responsible party.

Personal Rights responsible party signed by Resident R1.

Non-Discrimination Notice signed by Resident R1 as authorized representative.

Funeral Arrangements Document signed by Resident R1 as authorized representative.

ID and Emergency Information signed by Resident R1 as authorized representative.

Resident Appraisal signed by Resident R1 as authorized representative.

Release of Resident Client/Resident Medication signed by Resident R1 as authorized representative.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.