Complaint Investigation Report

The investigation revealed the following: Regarding the allegation “Staff do not respond to residents' calls for assistance in a timely manner,” it is alleged that staff is taking a long time to respond to a resident’s call light request. On 07/24/25, between 12:10 PM and 1:45 PM, LPA Gonzalez conducted interviews with S1-S6. Of those interviewed, 6 out of 6 staff denied the allegation. 5 out of 6 staff stated that they respond to a residents call light request within 5 minutes.

On 07/24/25, between 1:55 PM and 3:30 PM, LPA conducted interviews with R1-R3, and on 07/25/25 between 1:30 PM and 2:45 PM, LPA conducted interviews with R4-R7 and attempted to interview R8-R9. Of those interviewed, 6 out of 7 residents said staff responds to their call light request in a timely manner. 7 out of 7 residents stated that there is enough staff to meet their needs.

On 08/06/25, LPA Gonzalez reviewed the Personnel Roster (Dated: 07/01/2025) and observed that there is sufficient staff to meet the needs of the residents. Additionally, on 08/06/25, LPA Gonzalez inspected resident bedrooms #208 and #319 and observed call buttons to be in operable condition. ¬LPA Gonzalez observed Assistant Administrator, Jesus Chavez pull the call light cord and found that the facility staff responded in less than four minutes.

Based on record review, interviews, and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

Regarding the allegation “Staff do not ensure residents’ incontinence needs are being met,” it is alleged that residents are left in soiled briefs for extended periods of time. On 07/24/25, between 12:10 PM and 1:45 PM, LPA Gonzalez conducted interviews with S1-S6. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff stated that no residents is left in the same briefs for 24 hours or longer. 5 out of 6 staff stated that residents briefs are changed every 2 hours.