Complaint Investigation Report

Investigation consisted of the following:

On 06/16/2025, interviews were conducted, and records were gathered. Interviews conducted consisted of 10 resident interviews [Resident 1 (R1) to Resident 10 (R10) were interviewed] and 2 staff interviews [Staff 1 (S1) to Staff 2 (S2) were interviewed]. Resident 1’s records were gathered which consisted of Admission Agreement dated 01/01/2024, Identification and Emergency Information dated 10/26/2022, Physicians Report dated 10/10/2022, and Medication Administration Records (MAR) from 02/15/2025 to 06/14/2025. Facility records were gathered which consisted of Resident Roster dated 06/2025, and Personnel Report dated 01/2025. On 06/18/2025, interviews were conducted, records were reviewed, and a facility tour was conducted. Interviews conducted consisted of 6 staff interviews [Staff 3 (S3) to Staff 8 (S8) were interviewed]. Records reviewed consisted of R1’s records and facility records. Facility tour consisted of the medication room and the department observed staff providing medication to residents.