Inspection Report
Complaint Investigation
Capacity: 20
Deficiencies: 0
Aug 6, 2025
Visit Reason
The investigation was initiated due to allegations that the facility did not have adequate staff, Resident A's healthcare needs were not properly addressed, and that Relative A1 was not properly notified of a serious incident.
Findings
The investigation found no violations regarding staffing adequacy, Resident A's healthcare needs, or notification of incidents to Relative A1. Staff schedules showed no gaps, Resident A's care was managed according to physician orders, and Relative A1 was notified of a fall incident. Resident A was transferred to another facility during the investigation.
Complaint Details
The complaint alleged inadequate staffing, improper addressing of Resident A's healthcare needs including falls and nutrition, and failure to notify Relative A1 properly of a serious incident. All allegations were investigated and found not substantiated.
Report Facts
Facility capacity: 20
Complaint receipt date: Aug 4, 2025
Investigation initiation date: Aug 6, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Geoff Byron | Administrator | Interviewed regarding staffing and Resident A's care |
| Dwight Forde | Licensing Consultant | Conducted investigation and authored report |
Inspection Report
Complaint Investigation
Capacity: 20
Deficiencies: 0
Dec 27, 2024
Visit Reason
The investigation was initiated due to a complaint alleging employee verbal abuse of residents, leaving residents in soiled briefs causing skin problems, and substandard housekeeping resulting in ants and improperly changed bedding.
Findings
The investigation found no substantiated violations. Observations and interviews indicated employees treated residents with dignity, residents were properly cared for with no skin problems noted, and housekeeping standards were maintained with no evidence of ants or dirty bedding.
Complaint Details
Complaint received on 12/23/2024 alleging employees verbally abuse residents, leave residents in soiled briefs causing skin problems, and substandard housekeeping with ants and improper bedding changes. All allegations were investigated and found unsubstantiated.
Report Facts
Capacity: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kristina Peters | Employee | Interviewed during investigation regarding resident care and allegations |
| Jennifer Paulsen | Careline Nurse Practitioner | Interviewed by telephone regarding resident health care and skin conditions |
| Connie Clauson | Licensee Designee | Contacted for exit conference and advised of findings |
Inspection Report
Renewal
Census: 5
Capacity: 20
Deficiencies: 0
Mar 5, 2024
Visit Reason
The visit was conducted as a renewal inspection to determine compliance with licensing statutes and rules for the Adult Foster Care large group home license.
Findings
The facility was determined to be in substantial compliance with applicable rules and requirements, resulting in the recommendation for issuance of a 2-year regular adult foster care license.
Report Facts
Number of staff interviewed and/or observed: 4
Number of residents interviewed and/or observed: 5
Facility capacity: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Connie Clauson | Licensee/Licensee Designee | Named as Licensee/Licensee Designee |
| Keely Sanders | Administrator | Named as Administrator |
| Dwight Forde | Licensing Consultant | Author of the report and recommendation |
Inspection Report
Complaint Investigation
Capacity: 20
Deficiencies: 0
Oct 16, 2023
Visit Reason
The investigation was initiated due to complaints alleging no staff training, residents left in soiled clothing, resident bruises, and lack of use of hoyer lifts.
Findings
The investigation found no substantial violations. Allegations regarding residents left in soiled clothing, improper staff training on special equipment, and residents having bruises were all determined to be unsubstantiated based on interviews, documentation review, and observations.
Complaint Details
Complaint alleged no staff training, resident bruises, residents left in soiled clothing, and no use of hoyer lifts. All allegations were investigated and found not substantiated.
Report Facts
Capacity: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Keely Sanders | Administrator | Interviewed regarding staff training and facility operations |
| Connie Clauson | Licensee Designee | Attempted exit conference; unavailable |
| Dwight Forde | Licensing Consultant | Author of the report |
| Barbara Roberts | Resident Care Manager | Interviewed regarding complaints about resident care |
| India Mester | Staff Member | Interviewed about resident care and observations |
| Wendi Combs | Employee | File reviewed for training verification on use of hoyer lifts |
| Kristina Peters | Employee | Interviewed regarding observations of resident bruising |
Inspection Report
Complaint Investigation
Capacity: 20
Deficiencies: 1
Apr 26, 2023
Visit Reason
The investigation was initiated due to a complaint alleging that employees did not follow Resident A’s plan of care.
Findings
The investigation found that employees did not consistently follow Resident A’s plan of care, specifically failing to turn and change the resident as required, resulting in gaps in care documentation and Resident A being found in soiled clothing. The violation was established based on interviews and review of logs and hospice notes.
Complaint Details
Complaint investigation initiated on 04/19/2023 regarding failure to follow Resident A’s plan of care. Violation was established based on evidence that employees failed to turn Resident A every two hours and keep her dry as required.
Deficiencies (1)
| Description |
|---|
| Employees did not follow Resident A’s plan of care regarding turning and keeping the resident dry. |
Report Facts
Capacity: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Keely Sanders | Administrator | Interviewed regarding Resident A’s care and logs |
| Connie Clauson | Licensee Designee | Attempted exit conference contact |
| Cheryl Moore | Careline Medical Social Worker | Interviewed regarding gaps in Resident A’s care and logs |
| Jennifer Paulson | Careline Hospice Nurse Practitioner | Interviewed regarding Resident A’s care and wound condition |
Inspection Report
Complaint Investigation
Census: 8
Capacity: 20
Deficiencies: 0
Jan 24, 2023
Visit Reason
The inspection was conducted in response to complaints alleging understaffing, medication errors, improper toileting of residents, and moldy and dirty rooms at the facility.
Findings
No violations were established for any of the allegations. The home was found to be adequately staffed, medication errors were not substantiated, residents were properly toileted, and the facility was clean without mold or foul odors.
Complaint Details
The investigation was initiated following a complaint received on 2022-12-05 regarding understaffing, medication errors, improper toileting, and unclean rooms. All allegations were investigated and found to be unsubstantiated.
Report Facts
Capacity: 20
Census: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Athena Meza | Home Manager | Interviewed during the investigation denying staffing and medication error issues |
Inspection Report
Complaint Investigation
Capacity: 20
Deficiencies: 0
Jun 30, 2022
Visit Reason
The investigation was initiated due to complaints alleging staff sleeping during shifts, failure to provide proper medical care, and improper toileting and cleaning practices at the facility.
Findings
The investigation found no substantial violations. Staff sleeping was an isolated incident with disciplinary action taken. Medical care and resident hygiene were found to be properly managed with no evidence of neglect or improper care.
Complaint Details
Complaints alleged staff sleeping and not providing proper supervision, failure to provide proper medical care, and improper toileting and unclean rooms. All allegations were investigated and violations were not established.
Report Facts
Capacity: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Nicole Wingenfeld | Administrator | Interviewed regarding allegations and investigation findings |
| Wendy Combs | Staff member | Interviewed regarding staff sleeping and care allegations |
| Kristina Peters | Staff member | Interviewed regarding staff sleeping and care allegations |
| Sarah Humphrey | Careline Hospice nurse | Interviewed regarding resident wound care and medical care |
| John Mooneyham | Facility Director | Oversees cleaning process improvements |
| Adelina Cabello | Staff member disciplined for sleeping during shift |
Inspection Report
Original Licensing
Capacity: 20
Deficiencies: 0
Aug 26, 2019
Visit Reason
The visit was conducted as an original licensing study to determine compliance with applicable licensing statutes and administrative rules for the facility Tecumseh Place I.
Findings
The facility was found to be in substantial compliance with licensing requirements, including physical facility standards, program descriptions, and staff qualifications. A temporary license with a maximum capacity of 20 residents was recommended and issued.
Report Facts
Facility capacity: 20
Facility size: 9682
Number of bedrooms: 20
Room dimensions: 144
Living space: 1000
Staff to resident ratio: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jeffrey J. Bozsik | Licensing Consultant | Author of the licensing study report and recommendation |
| Connie Clauson | Administrator/Licensee Designee | Facility administrator and licensee designee |
| Ardra Hunter | Area Manager | Approved the licensing recommendation |
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