Complaint Investigation Report

Allegation: Staff spoke to client inappropriately

It is alleged that staff spoke inappropriately to clients in care. It was reported that staff yelled at Client #1 (C1), which made C1 uncomfortable. To investigate this allegation, the Regional Office (RO) received an audio recording from a client at the facility on 04/16/2024. The recording reportedly captured a client stating that staff spoke inappropriately to clients in care. However, the exact date and time of when the recording occurred are unknown. The location of the recording could not be verified according to the client indicating that it took place within the facility, and the client was unable to identify the staff involved.

During the initial visit on 04/24/2025, LPAs conducted an interview with the Administrator, who denied the allegation. Interviews were conducted with two (2) staff, one (1) of whom reported concerns regarding tone when addressing clients; however, the information obtained was inconsistent and could not be corroborated. Interviews with two (2) clients revealed that one (1) client reported raised voices, while the other denied any inappropriate communication. Due to the lack of identifiable individuals and the unknown date and time of the recording, the audio could not be authenticated and could not be used to conclusively support the allegation. Based on interviews and lack of corroborating evidence, there is insufficient evidence to determine that staff spoke inappropriately to clients in care. Therefore, this allegation is UNSUBSTANTIATED .

It is alleged that staff threatened to hit Client #1 (C1). To investigate this allegation, the Regional Office (RO) received an audio recording on 04/16/2024 from a client at the facility, which reportedly captured an incident in which C1 was threatened by staff. However, the exact date and time of when the recording occurred are unknown. The location of the recording could not be verified beyond the client indicating that it took place within the facility, and the client was unable to identify the staff involved. The RO referred the case to the Investigation Branch (IB) on 04/30/2025. The department conducted interviews with the Administrator and two (2) staff. On 05/13/2025, the Administrator and Staff #1 (S1) denied the allegation. On 05/20/2025, Staff #2 (S2) also denied the allegation. On 06/25/2025, Staff #1 (S1) was re-interviewed and provided an opportunity to listen to the audio recording; S1 denied that the voice in the recording was theirs. Due to the lack of identifiable individuals and the unknown date and time of the recording, the audio could not be conclusively authenticated. Additionally, no witnesses corroborated the allegation. Based on the information gathered, there is insufficient evidence to determine that staff threatened C1. Therefore, this allegation is UNSUBSTANTIATED . Continue on LIC 9099C