Complaint Investigation Report

Allegation #1: Staff did not respond to emergency call button in a timely manne r.

The complaint alleged that on 04/26/2022, at approximately midnight, the resident (R1) pulled the emergency string, but the alarm could not be heard down the hall. On 10/22/2025, LPA Richard reviewed the records of LPA Tricia Danielson interviewing three staff members #1-3 (S1-S3). All stated that the alarm system had been upgraded a week earlier and was functioning properly. Records showed that the LPA sounded the alarm, and staff arrived within 2 minutes. On 10/22/2025, LPA Richard reviewed the records of LPA Danielson's interview with five residents #1-5 (R1-R5). Two out of five confirmed the allegations. The LPA Danielson reviewed the facility alarm response records; no string was pulled from R1's room. A review of the LPA records indicated that the Ombudsman confirmed the facility reported to them that the alarm system was working correctly.

Based on observation, interviews, and record reviews, the preponderance of evidence has not been met. Although the allegation may have occurred or be valid, there is insufficient evidence to determine whether the alleged violation occurred; thus, the allegation is unsubstantiated.