Inspection Reports for Lotus Villa Memory Care

An unannounced complaint investigation visit was conducted in response to multiple allegations received on 12/15/2023 regarding resident care concerns at Lotus Villa and Memory Care Facility.

The investigation included interviews, observations, and record reviews related to allegations of inadequate follow-up on resident condition changes, poor hygiene, hydration, feeding, and medication assistance. The findings determined all allegations to be unsubstantiated based on evidence and interviews.

The complaint investigation was triggered by allegations that staff did not follow up on a resident's change of condition, left a resident in filthy clothes, failed to ensure hydration and proper feeding, and did not provide proper medication assistance. The investigation found no preponderance of evidence to substantiate these allegations.

The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2024-04-16 alleging multiple issues including failure to administer insulin as prescribed, resident injury, lack of phone access, inadequate cleaning, facility disrepair, and failure to follow diabetic diet.

The investigation substantiated the allegation that facility staff did not administer insulin as prescribed to a resident due to medication being misplaced. Other allegations including resident injury, phone access, bathroom cleaning, facility disrepair, and diabetic diet were found unsubstantiated based on interviews, observations, and record reviews.

The complaint investigation was substantiated for the allegation that facility staff failed to administer insulin medication as prescribed to resident #1 because the insulin was misplaced in the medication room refrigerator and not given on time. Other allegations including resident injury, phone access, bathroom cleanliness, facility disrepair, and diabetic diet noncompliance were unsubstantiated.

An unannounced complaint investigation visit was conducted in response to allegations received on 2024-08-30 regarding dehydration, COVID outbreak prevention, reporting of resident condition changes, and adequacy of care at the facility.

The investigation, which included interviews, observations, and record reviews, found all allegations to be unsubstantiated based on corroborating evidence and resident and staff interviews indicating appropriate care and procedures were followed.

The complaint investigation was unsubstantiated, meaning there was not a preponderance of evidence to prove the alleged violations occurred. Allegations included dehydration, failure to prevent COVID outbreak, failure to report resident condition changes, and inadequate care, all of which were found unsubstantiated after investigation.

An unannounced complaint investigation visit was conducted in response to allegations received on 2025-04-18 regarding staff safeguarding resident's personal items, preventing falls, preventing altercations, and responding to call lights.

The investigation included interviews, observations, and record reviews. All allegations were determined to be unsubstantiated due to lack of preponderance of evidence. The facility had programs and procedures in place related to the allegations, and residents and staff provided explanations consistent with the findings.

The complaint involved four allegations: staff did not safeguard resident's personal item, did not prevent falls, did not prevent altercations, and did not respond timely to call lights. After investigation, all allegations were found unsubstantiated.

The visit was an unannounced complaint investigation conducted in response to a complaint received on 2025-02-10 regarding multiple allegations of staff neglect and inadequate care at the facility.

The investigation included interviews, observations, and record reviews related to five allegations. All allegations were found to be unsubstantiated based on evidence and interviews with the resident and staff.

The complaint included allegations of staff neglect resulting in a resident fall, inadequate cleaning and odor control in a resident's room, failure to safeguard personal belongings, and lack of assistance with personal hygiene care. The investigation found no evidence to substantiate these allegations.

An unannounced complaint investigation visit was conducted in response to allegations received on 2025-02-13 regarding financial abuse of residents, staff not responding to residents' requests for assistance, and staff not according dignity to residents.

The investigation, which included interviews with residents, staff, and review of records, found no evidence to substantiate the allegations. Residents and staff denied the claims, and the Licensing Program Analyst determined the allegations to be unsubstantiated.

The complaint investigation was unsubstantiated, meaning there was not a preponderance of evidence to prove the alleged violations occurred. Allegations included financial abuse, lack of staff response to assistance requests, and lack of dignity accorded to residents.

The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2024-07-16 alleging that a resident sustained multiple falls due to lack of supervision.

The investigation included interviews, observations, and record reviews. The Licensing Program Analyst found that the resident was ambulatory with assistance and received escorting and observation checks as needed. Interviews with residents and staff did not corroborate the allegation of lack of supervision or mistreatment. The allegation was determined to be unsubstantiated due to insufficient evidence.

The complaint alleged that a resident sustained multiple falls due to lack of supervision. The investigation found no evidence to substantiate the allegation. The allegation was deemed unsubstantiated.

The inspection visit was an unannounced complaint investigation triggered by a complaint received on 2024-09-16 alleging that the facility was not meeting resident care needs and neglect/lack of supervision resulting in a resident sustaining a rib fracture.

The investigation substantiated the allegation that the facility did not meet resident care needs, specifically related to a resident developing a diaper rash due to being left on a soiled diaper for a prolonged period. The allegation of neglect/lack of supervision resulting in a rib fracture was unsubstantiated due to insufficient evidence.

The complaint investigation was substantiated for the allegation that the facility failed to meet resident care needs, evidenced by a resident developing a diaper rash from being left on a soiled diaper. The allegation of neglect and lack of supervision causing a rib fracture was unsubstantiated after interviews and record reviews.

The visit was an unannounced required comprehensive annual inspection of the Residential Care Facility for Elderly (RCFE).

The facility was found to be operating within approved capacity and in good repair with no obstructions or safety hazards. Resident rooms and common areas were adequately furnished and maintained. Medications were properly stored and dispensed. Staff had required clearances and certifications. No deficiencies were cited during this inspection.

Unannounced complaint investigation visit conducted in response to allegations received on 06/10/2024 regarding resident records maintenance, infection control, and medication storage and security.

The investigation found that resident records were properly maintained and secured, infection control requirements were followed with no current incidents of scabies, and residents' medications were properly stored and secured. All allegations were determined to be unsubstantiated due to lack of evidence.

The complaint investigation was unsubstantiated, meaning there was not a preponderance of evidence to prove the alleged violations occurred.

An unannounced complaint investigation visit was conducted in response to allegations received on 2024-04-16 regarding staff mistreatment and physical assault of residents.

The investigation included interviews with staff and residents and review of records. All allegations, including staff not treating residents with respect and staff slapping a resident, were found to be unsubstantiated due to lack of preponderance of evidence.

The complaint investigation was unsubstantiated. Allegations included staff did not treat resident with respect and staff slapped resident. Interviews with staff and residents did not support the allegations, and no evidence was found to prove the violations occurred.

An unannounced complaint investigation visit was conducted in response to an allegation that staff did not properly address a resident's multiple falls resulting in injuries.

The investigation found that Resident #1 sustained two falls requiring medical treatment. The facility updated the resident's care plan to address fall prevention and has sufficient staffing to meet resident needs. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.

The complaint alleged that staff did not properly address a resident's multiple falls resulting in injuries. The allegation was found unsubstantiated after investigation.

The inspection was conducted as an unannounced complaint investigation following a complaint received on 2024-03-25 alleging that staff serve food of poor quality.

The Licensing Program Analyst conducted interviews, reviewed records, and observed meals during two separate visits. The investigation found that food served was of adequate quality, fresh, balanced, and consistent with the menu. The allegation was determined to be unsubstantiated due to lack of preponderance of evidence.

The complaint alleging poor quality food was investigated and found to be unsubstantiated.

An announced pre-licensing visit was conducted to evaluate the facility for a Residential Care Facility for Elderly (RCFE) license with a capacity of 99 residents.

The facility was found to be in good repair with no hazards, all resident bedrooms and bathrooms adequately furnished and maintained, safety equipment functional, and emergency plans posted. No corrections were needed following the inspection.

An announced pre-licensing visit was conducted to evaluate the facility's readiness for licensing as a Residential Care Facility for Elderly (RCFE) with 93 non-ambulatory and 6 bedridden beds.

The inspection identified multiple deficiencies including environmental safety issues such as non-working lights, broken windows, blocked emergency exits, unsecured chemicals, and fire safety concerns with propped open fire doors. Personnel records were incomplete with missing CPR training and absent criminal record clearances. Water temperatures were below required levels and auditory devices were missing in the dementia care unit.

The visit was conducted as part of the original licensing process (CHOW application) for Lotus Villa and Memory Care facility to verify compliance with community care facility licensing laws and readiness for operation.

The applicant and administrator participated in a telephone interview (COMP II) confirming their understanding of licensing laws, facility operation, admission policies, staffing requirements, emergency preparedness, complaints reporting, and pre-licensing readiness. Identification was verified and required documentation obtained.