Complaint Investigation Report

The investigation revealed the following:

Allegation: "Staff interacted with a resident in an inappropriate manner ." It is alleged that a staff was sexually harassing staff, drugging staff, and grooming and flirting with residents. No additional information provided. All (6) staff interviewed including the alleged perpetrator denied the allegation, stating that they are trained in abuse/neglect. Staff stated this is the first time they’ve heard about this and have not witnessed anyone making unwanted sexual advances or intimidating other staff or residents. S1 stated that police was called due to domestic issue between (2) residents, but no arrests made. All (12) residents interviewed denied the allegation, stating that none of the staff have engaged in any behavior that could be interpreted as flirting or grooming. Residents also stated that they have not observed any staff behaving unprofessionally around them. Documents reviewed revealed that the staff accused of this behavior had no history of sexual misconduct nor prior disciplinary actions. During the visits on 06/30/2026 and 07/24/2026, LPA did not observe inappropriate behavior from any staff. Therefore, there was insufficient evidence to corroborate with this allegation.

Allegation: "Staff are not following residents dietary plan ." It is alleged that staff are unaware of residents' dietary plans and restrictions, leading to cross-contamination of food allergens. It is also alleged that a resident was served cross contaminated food, and there was a choking incident two to three months ago due to staff not chopping food. (6) of (6) staff interviewed denied the allegation, stating that a process is in place anytime a resident's diet is changed. S1 stated that a dietitian is involved in meal planning to meet the residents' dietary needs. Some staff explained that whenever there is a new resident with a special diet or dietary changes, a diet order is generated and sent to the food services director, who then notifies the kitchen staff. S5 stated that the kitchen has a dietary board list of allergies and restricted diets along with pictures of the residents. Residents interviewed denied the allegation, stating that staff are aware of their dietary plans and restrictions. Some residents indicated that they have seen a resident coughing while eating but not choking. LPA reviewed incident reports (January-June 2026) submitted to CCLD and found no incidents of food allergen cross-contamination or choking. Records reviewed indicated that the kitchen staff have the proper food handling and safety training. During the visits on 06/30/2026 and 07/24/2026, LPA observed the board in the kitchen that staff could see and there was no inappropriate food served during lunch. Therefore, there was insufficient evidence to corroborate with this allegation.