Complaint Investigation Report

On 09/03/2021, during the investigation inspection LPA’s and LPM observed and Administrator admitted she only has the following personnel: Administrator works as Caregiver, 1 Med-Tech/Caregiver, and 1 Housekeeper for 74 clients. Administrator also admitted to not having no Activity Director, therefore, there are no scheduled activities. Facility was observed to be in serious disrepair and lacking cleanliness as stated below. Thus, the allegation that the facility is not providing care and supervision to clients is Substantiated.

On 09/03/2021, LPM and LPAs observed the following in the first floor kitchen: grime on the floor, a leaking dishwasher with dirty water dripping into a bowl on the floor, an unused mini fridge with large deposits of black mold and brown material, dirty dining tablecloths, tables excessive amount of clutter in Room 108, dirty wall in Room 105 and Room 109, strong smell of smoke in Room 106, and old dirty mattress in Room 114. On the second floor, LPM and LPAs observed all public restrooms lacked soap, paper towels, and toilet paper, and one public restroom had mold on the shower mat. In multiple client rooms on the second floor, LPM and LPAs observed stains on the floors and carpets, stains on the walls, and stains on the beds. For example, LPM and LPAs observed and/or noted a very strong smell of smoke in Room 202A, crumbs all over the floor in Room 205, stains on the floor and mold/water stains on the ceiling and mattress sitting on bricks and strong smell of marijuana, a stained bed in Room 207, dirty walls and a water leak and rust under the toilet in the bathroom of Room 210, multiple cigarette butts on the dresser in Room 212, dirty mattresses and cigarette ashes on the floor in Room 216, and a dirty air vent in Room 218. Thus, the allegation that the facility is not clean and sanitary is Substantiated.

On 09/03/21, LPM and LPAs observed the following in the first floor kitchen: a large square hole in the ceiling, a leaking dishwasher with dirty water dripping into a bowl on the floor, a broken ice machine, a broken glass window, and, in the adjacent outdoor space, a large outdoor umbrella with the pole broken in half exposing a sharp point; sink is off wall in Room 104, glass is off window frame in Room 111, broken blinds in Room 113. In the stairs to the second floor, the mechanism to hold a door open was not functioning and the door was observed tied open with plastic bags. On the second floor, LPM and LPAs observed exposed wires coming from the ceiling and in multiple rooms beds in disrepair, holes and scratches in the walls and floors, broken closet doors, damaged beds, chairs, and dressers, and lamps missing lamp shades. For example, LPM and LPAs observed a bed in disrepair and a hole in the wall in Room 207, a broken closet door and holes in the floor in Room 202, a dresser in disrepair and a broken closet door in Room 204, and a broken chair and a lamp missing a lamp shade in Room 218. Thus, the allegation that the facility is not in good repair is Substantiated