Complaint Investigation Report

The Department interviews with clients revealed that nine out of nine clients stated transportation for some outings have been cancelled or postponed. Three out of nine clients stated outings have been cancelled or postponed due to only having one care coordinator (CC) available at the house to supervise them. One out of the remaining six clients stated outings were cancelled or postponed due to no vehicle available to use during a scheduled outing. The remaining five out of five clients stated outings were cancelled or postponed due to both only having only one CC and no vehicle available to use during a scheduled outing. The Department interviews with staff regarding this allegation revealed that two out of five staff stated outings can be postponed if not enough staff is available to facilitate outings. One out of two staff added outings have been canceled due to not enough staff and or no vehicle available. The remaining three staff were unsure if outings have been postponed or cancelled. Upon record review for the week of July 12, 2025 through July 18, 2025, there were two CCs available for two out of 21 shifts. All other shifts had one CC available.

Regarding the allegation staff refused to allow resident the use of a laptop to attend community meetings, it was reported staff did not give laptop access to C1 due to lack of staff to supervise usage.

Upon records review the Department observed C1's admission agreement under the Basic Services section line Q that states, “Assistance with access to supportive services such as… community support groups, fitness and recreational activities, and vocational support services”. Staff notes dated February 13, 2025 revealed that at 5:35AM, C1 attempted to attend an online AA meeting, but was denied due to staff doing a medication audit and was told they could attend the next meeting at 6:30AM. At 2:18PM staff notes revealed that C1 had not attended a meeting at all the morning of February 13, 2025. Upon interviews it was revealed that 5 of 9 clients have asked to use a device but were denied access due to the lack of staffing being able to monitor the device being used. During interviews with staff, it was revealed that 4 of 6 staff stated that they have to monitor the clients when they are using devices and 4 of 6 staff stated that the client coordinators often work a shift alone.

Regarding the allegation licensee did not allow resident access to personal items, it was reported clients are not allowed access to shavers when needed.