Complaint Investigation Report

Interview with S1 indicated S1 saw scratch on R1’s forehead while interview with R2 indicated that R2 saw blue marking on R1’s forehead the morning of 02/23/2022. Both S1 and R2 indicated that they did not witness R1’s fall. LPA Brown was not able to corroborate the allegation that resident fell while in care.

The second allegation indicates facility has inappropriate locking devices on residents’ bedroom door. LPA conducted interviews with resident, staffs and hospice care nurses. Resident, staffs and hospice nurses interviews indicated that the facility do not have inappropriate locking devices on residents room. LPA Brown was not able to corroborate the allegation that the facility has inappropriate locking device on residents’ room.

Therefore, the allegation resident fell while in care (allegation #1) and facility has inappropriate locking devices on residents’ bedroom door (allegation #2) are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur.

An exit interview was conducted where this report (LIC9099) was discussed and provided to Licensee/Administrator Letitia Isai.