Complaint Investigation Report

Allegation: Staff falsified residents' signature. It is alleged that resident (R1's) signature was falsified on "Release of Resident Medical Information" and "Consent for Emergency Medical Treatment.." The complaint alleges that staff falsified their signature so that the resident was able to be seen by the in-house physician, as well as that a med-tech staff falsified R1's signature stating the resident was given their medications on 12/24/24. According to the complaint, R1 was not at the facility on (12/24/25), the date medications were allegedly given to the resident. Staff interviewed denied the allegation. Record review of forms: "Release of Resident Medical Information" and "Consent for Emergency Medical Treatment" did not indicate there was signature falsification because they were electronically signed by R1 on 11/7/24 via Dropbox Sign. However, on 12/24/25, the facility filled out a Medication Release form. Resident (R1's) signature on that date was compared to other document signatures. The signature appears different and inconsistent with the majority of signatures on record. Copies of the Medication Release forms were obtained. There is sufficient evidence to support the allegation.

Allegation: Staff does not ensure facility is in good repair. The complaint alleges the facility surveillance cameras are inoperable. According to information obtained, residents had an understanding the facility has surveillance cameras for their safety. However, in recent months many of the cameras have not been working. A total of 14 residents were interviewed, all the residents interviewed had knowledge of video surveillance in the building. However, the majority of the residents stated they do not know whether all the cameras are operable. Staff interviews confirmed that there are exterior cameras throughout the property, and that the majority of the interior cameras were removed. LPA observed one (1) surveillance camera in the hallway by the lobby area. Executive Director stated the camera video does not show on the main office monitor, and at this time only 3 cameras are displayed in the office surveillance monitor. Based on observation, the facility has multiple cameras, of which only 3 are showing as operable as of today.

Based on observation and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED .

An exit interview was conducted with Executive Director Jacqueline Cortez. A copy of the report and appeal rights were issued.