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32 | Facility submitted a copy of the resident roster and staff roster. LPA interviewed Administrator, Staff #2 (S2) to Staff #4 (S4), and Resident #1 (R1) to Resident #4 (R4) and Former Resident #1 (FR1). LPA was unable to interview Staff #1 (S1) due to language barrier. LPA reviewed and obtained documents from S1 to Staff #3 (S3’s) files that include: Staff Training and pertinent documents. LPA requested the monthly meal schedule and snack list. LPA toured the facility. LPA requested the Bed Repositioning Logs, Fire and Disaster Drill logs.
On 02/06/2026, LPA spoke to the Administrator over the phone and obtained S4’s staff training documents. LPA interviewed Staff #4 (S4) over the phone.
During today's visit, LPA obtained the following documents: staff and resident rosters.
The investigation revealed the following: In regards to the allegation: “Staff did not properly maintain floor surfaces.” It is alleged that the staff were more into cleaning than resident care and water was left on the floor during cleaning and not properly dried to prevent a fall risk. LPA interviewed the Administrator and three (3) out of four (4) staff that denied the allegation stating that they clean and properly dry the floor. LPA was unable to interview Staff #1 (S1) due to language barrier. LPA interviewed three (3) out of four (4) residents that denied the allegation stating that floors are kept clean, dry, and staff ensure that the residents are safe from falls after the floors are cleaned. LPA interviewed one (1) out of four (4) residents and one (1) former resident that corroborated with the allegation stating that the staff clean the floor often, which causes the floors to be kept wet and slippery and can cause a resident to fall. LPA toured the facility and observed the floors in the kitchen, dining room, hallways, resident bedrooms, and bathrooms were all clean, dry, and not wet nor slippery. There is not enough evidence to substantiate.
Allegation: “Staff spoke inappropriately towards the residents.” It is alleged that the staff were not talking to the residents with dignity, respect and love. It is also alleged that the residents are afraid to report due to fear of retaliation. LPA interviewed the Administrator and three (3) out of four (4) staff that denied the allegation stating that all staff speak with residents with respect, dignity, and love and have not witnessed any other staff speak to residents without respect, dignity, and love. LPA was unable to interview Staff #1 (S1) due to language barrier. LPA interviewed one (1) out of four (4) residents and one (1) former resident that stated that there are some staff that speak to them in a frustrated and unfriendly tone but stated that there are some staff that treat them in a pleasant manner. LPA interviewed three (3) out of four (4) residents that denied the allegation stating that they are treated by staff with dignity, respect, and love and have not been mistreated by staff. There is not enough evidence to substantiate.
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