Complaint Investigation Report

Four out of four staff denied the allegation stating the facility phone is available to residents in care. Two out of four residents denied the allegation as they utilize their own cell phones and is permitted to use the facility phone if needed. The third resident provided conflicting statements, and LPAs were unable to qualify the fourth resident due to their medical condition.

Regarding the allegation, Staff denied resident access to their personal wheelchair, it is alleged that Resident #3 (R3) was denied access to their wheelchair, and the wheelchair was refused to be repaired, making it impossible for R3 to leave the facility. Based on observations, LPAs observed R3 using a walker. LPA Bentley observed the manual and electric wheelchairs in the garage designated for R3 also confirmed by R3. R3 stated during the interview that the new wheelchair is working and the old wheelchair is not working due to a broken joystick. R3 indicated there was a one year delay in receiving the new electric wheelchair due to pending insurance approvals, however, was able to utilize a manual wheelchair while waiting for the new electric version. Four out of four staff reported that R3 is the only resident that uses a wheelchair and uses the wheelchair on the weekends and when they travel longer distances. Three out of four staff confirmed that the wheelchair has been in disrepair in the past. Two out of four staff interviewed denied the allegation while one staff was not employed at the time and the last staff did not provide a clear response. In review of the Individual Program Plan dated January 17, 2023 and Resident Rosters dated May 12, 2022 and November 15, 2025, Resident #5 (R5) is/was not a resident of this facility. LPA was unable to interview Resident #6 (R6) as no record was available due to R6 moving out in 2016.

Regarding the allegation, Staff monitors residents via hidden cameras, it is alleged that the licensee placed hidden cameras in the public rooms and bedrooms without the knowledge and consent of the residents or their families. It is also alleged that the cameras can be found hidden in faux alarm clocks. During the investigation, LPA Bentley observed clocks in all residents’ bedrooms but did not find any evidence of hidden cameras as well as around the room. LPAs observed four visible surveillance cameras. There are three Google Nest cameras. One is present in the living room, the second is mounted on the exterior roof in the front entryway, and the third is also mounted on the back patio roof. There is an additional Ring camera on the exterior front gate. All cameras have an audio component evidenced by the administrator’s Google Nest and Ring app accounts. Three of four residents confirmed the presence of these cameras in the common areas and denied there being any hidden cameras in their bedrooms. Four out of four staff denied the allegation. A record review of each resident’s admission agreements revealed that each resident signed and acknowledged that the facility is “under 24 hour surveillance.”