Complaint Investigation Report

Regarding the allegations: 1.) Staff pushed resident. 2.) Staff are violating resident’s personal rights. 3.) Staff threatened resident. 4.) Water temperature not within required range. On 05/09/2024, the Department received a complaint alleging Staff #1 (S1) and Staff #2 (S2) forcing Resident #1 (R1) into taking a shower in which the water was inconsistent going from scolding hot to ice cold. It was alleged that S1 and S2 threaten R1 and pushed R1 causing R1 to fall. During the initial visit, interview with R1 revealed little to no information regarding the allegations. R1 did not comment on the allegations and stated that there are no concerns regarding staff. R1 did state that R1 can control the shower’s temperature however that the shower controls can be difficult to navigate. Interview with ED conducted on 06/30/2025, revealed that R1 is no longer at the facility. The ED revealed that during the time of the alleged incident, the facility conducted an internal investigation in which both S1 and S2 denied the allegations. The ED stated that after their internal investigation, S1 and S2 were reassigned to work on different floors. The LPA conducted an interview with S1 during today’s visit; S1 denied the allegations. Residents interviewed did not voice any concerns regarding staff. Staff interviews revealed that they have not observed or heard of staff pushing residents or threatening residents. During the initial and subsequent visit, the LPA tested the water temperature throughout the building and found the water temperature to be within required range. The information obtained during the investigation did not include evidence sufficient to corroborate the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed Unsubstantiated at this time.

Exit interview conducted with Courtney Barber . A copy of the report was provided.