Marymount Villa Retirement Center.

Continued from LIC9099. Allegation: Staff interfered with resident visitation Finding: Unsubstantiated During investigation, LPA conducted interviews with W1, W2, W3, residents, staff and reviewed R1’s documents. Review of R1’s admission agreement dated 11/13/2023 showed that the visitation hours are 7 days a week from 9AM to 7PM. S1 stated that W1 has come to the facility to see R1 but not during visitation hours. S2 stated that W1 has come to the facility at 6am or even at 8pm (not sure on exact dates). W1 stated that they have come to the facility to visit R1 but not during visitation hours due to their work schedule. W1 stated that the facility has accommodated W1 with seeing R1 not within the visitation hours. S1, S2, S3, S4, and W1 stated that R1 has a roommate. S2 stated that for all residents, if a resident has visitors but they have a roommate, the visitors are still allowed to visit them in their room, but the visitors do have a limit on how long they can be in the room out of respect for their roommate. Based upon the interviews and record review conducted during the investigation, the above allegation is 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 the evidence to prove that the alleged violation occurred. Exit interview conducted with Bessy and a copy of report provided.

Continued from LIC9099. Allegation: Licensee is financially abusing resident in care. Finding: Unsubstantiated Based on interviews with staff and W1 revealed that R1 receives monthly income from Supplemental Security Income (SSI) and the remaining income was provided by the family. Interview with complainant indicated that R1 was being charged private room rate when R1 did not request to be in a private room. There was a lack of evidence that licensee is financially abusing R1. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED . No deficiencies are being cited on this date. Exit interview conducted with Dolly Rizvi and a copy of this report provided.

On 11/7/2025, at 2:45 PM, Licensing Program Analysts (LPAs), Y. Brown and L. Hall arrived unannounced conduct a case management health and safety check. LPAs met with Bessy John, Care Coordinator. LPA toured the facility with the Bessy John, Care Coordinator, including but not limited to residents' apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. There are no imminent health/safety concerns on today's date. No deficiencies cited during the Health and Safety visit. Exit interview conducted and a copy of this report provided.

CONTINUE FROM LIC9099 Allegation: Due to lack of supervision, a resident physically assaulted another resident resulting in injury and hospitalization Investigation Finding: Unsubstantiated The Department interviewed R1, R2, S2, S1, S3, S4, and S5. Staff reported that during lunch service, R1 was heard screaming from R1s room, and that Staff immediately responded. S4 stated seeing R2 leaving R1s room, then found R1 on the floor with blood and what appeared to be defensive wounds. Per Staff, R1 reported that R2 was in her room and in her closet when R1 attempted to stop R2, whereby both had struck the other. R1 had fallen backwards. R2 was unable to provide information related to the event. Review of a police report responding to the incident showed that there was no determination as to whether an assault had taken place or if R1 had an unwitnessed fall. R1 was immediately transferred to hospital where it was found that R1 had sustained a fracture, a cut above the eyebrow, and bruising. Hospital records indicate that R1 also had a back injury. It was indeterminate when that injury took place and it was noted that it could have been associated with R1s overall condition. A review of R1’s file did not indicate that R1 was a fall risk, and there was no record to indicate a history of falling at the facility. There was also no information to suggest that R1 had displayed a history of aggression. The Needs and Services Plan and the Physician’s report had no information to indicate that R1 needed additional supervision. A review of R2’s file indicated a history of aggression towards staff, but had no information to indicate known aggression towards other residents. There was no indication of R2 needing additional supervision, or a 1:1 caregiver. All staff interviewed stated having no knowledge of R2 having a behavior of aggression towards other residents. 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. Therefore, the allegation is Unsubstantiated. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 CONTINUE FROM LIC 9099 Allegation: Resident In care was diagnosed with severe dehydration Investigation Finding: Unsubstantiated Interviews and record review (R1’s care notes) revealed that R1 was provided water, ensures, and juices. Charting shows that R1 was drinking the liquids that were provided to R1, however charting also revealed that R1 would on some occasions skip the ensure but would drink the water and juices provided. Interview with S1 revealed that R1 drank beverages on R1 own and was vocal about what drinks R1 wanted, and staff would provide and chart. Interview with S2 revealed that R1 loved coffee and would drink beverages on R1s own and that staff would measure intake. Interview with S3 revealed that R1 would drink beverages on R1s own and staff kept track of R1s intake. Interview with S4 revealed that R1 would drink beverages on R1s own and that staff would keep track on R1s intake. The Department obtained and reviewed R1s hospitalization report and there was no information to indicate that the resident had been dehydrated. 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. Therefore, the allegation is Unsubstantiated . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 CONTINUE FROM LIC9099 Allegation: Staff did not assist resident with feeding Investigation Finding: Unsubstantiated Interviews and record review revealed that R1 is able to feed self. Review of R1’s physician report shows that R1 is able to feed self. Interview with S1 revealed that R1 ate on own. Staff would prepare the food and bring it to R1 but staff never assisted with feeding. S1 stated that R1 also liked extra snacks and food and would eat on R1’s own. Interview with S2 revealed that R1 ate on R1s own and no one had to assist R1 with feeding. S2 also stated that staff would ask R1 if R1 wanted snacks and R1 would eat them all. Interview with S3 revealed that R1 would feed R1 self and staff would keep track of how much R1 ate and drank and that R1 ate normal portions and would give snacks and R1 would eat them and loves coffee. Interview with S4 revealed that R1 would eat all food in R1s room on R1’s own and that the facility provided R1 with water, ensure, coffee and tea and R1 would eat and drink normal portions. S4 stated that staff has never fed R1, R1 and without assistance. A review of the Needs & Services plan and the Physician’s report indicated that R1 is capable of feeding self. 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. Therefore, the allegation is Unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove it; therefore, the allegations are UNSUBSTANTIATED. No deficiency was cited during this visit. Exit interview conducted and a copy of this report provided.

Page 2 Allegation: Staff refused to accept resident (R1) back to the facility after an emergency (ER) visit. The reporting party (RP) stated that the facility administrator (ED) refused to accept R1 back to the facility due to a bed issue. The RP stated that R1’s semi electric bed which was brought to the facility from R1’s home was broken and unless R1 is provided with a replacement bed, either a hospital bed or another semi electric bed, ED won’t admit R1 back, and that ED said R1 has not eaten in 24 hours and has become agitated because of the bed being broken. ED denied the allegation that she refused to admit R1 back. ED stated the staff reported to her on 7/17/22 that the remote control of R1’s bed was broken and that R1’s daughters (FM1 and FM2) came to the facility on 7/18/22 and R1 was agitated because of the bed being broken and would not eat. R1 can feed self but would not want the staff put pillow to elevate/raise her head and was refusing to eat that day. ED also stated that she told the hospital several times to arrange the rental bed which will take only one hour, and that they can send the bill to the facility and the facility will get paid by the responsible party. ED further stated she told FM1 and FM2 they can rent a hospital bed temporarily, but the daughters were saying the insurance would not cover 100% of the cost. FM1 and FM2 told them to call 9-1-1 so R1 was sent out. R1 may also have UTI because R1 was very agitated that day. R1 was discharged back to the facility on 7/19/ 22. R1 stated not remembering what happened to her bed. LPA observed R1’s bed was working on 7/27/22. LPA tried to reach to FM1 and FM2 to obtain information, but they did not return LPA’s call. S1 and S4 confirmed ED’s statement that the remote control of R1’s bed was broken and that R1 was agitated and refusing to eat. S1 stated R1’s bed was broken on and off and the issue reported to R1’s daughters. S1 also stated that R1 was sent out on 7/18/22 and discharged back on 7/19/22. Hospital After Visit Summary showed R1 was admitted on 7/18/22 for feeding and behavior problems and discharged on 7/19/22. Based on information gathered and LPA unable to obtain information from FM1 and FM2, the allegation is unsubstantiated. ....continued on 9099C (page 3) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Page 3 Allegation: Staff did not ensure that resident's (R1) bed was in working condition. S1 stated R1's bed has been on and off broken and R1’s daughters were informed and aware. Prior to the last time the bed was broken on 7/17/22, the daughter sent a motor to the facility and the motor of the bed was replaced. The bed was not a hospital bed, but part of the bed can be raised with a remote control. S4 confirmed that the remote control of R1’s bed was broken. During interview on 7/27/22, R1 was not able to provide information about her bed but stated she’s happy. LPA observed R1’s bed was working that day. LPA tried to reach to FM1 and FM2 to obtain information, but they did not return LPA’s call. Based on information gathered and LPA unable to obtain information from FM1 and FM2, the allegation is unsubstantiated. Allegation: Staff did not ensure that resident (R1) was adequately fed. S2 stated she fed residents during her shift and if residents refused to eat, she reported to her supervisor and facility nurse who gave her instructions what to do and she followed the instructions. S2 further stated they cannot force feed the residents, and that residents have right to refuse, but she came back and offer food 2 or 3x. She documented if resident still refused. S4 stated the caregivers were feeding R1. S4 also stated that R1 knew that R1 has medications that needed to be taken with food. S4 further stated that she does not remember any incident where caregivers refused and/or didn't feed R1. R1 stated she likes to eat dinner at 5:00 p.m. and dinner is already prepared at that time but was not able to provide information if caregivers refused to give her food. ....continued on 9099C (page 4) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Page 4 Based on information gathered and LPA unable to obtain information from FM1 and FM2, the allegation is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of this report provided.

At 12:30 pm on this day, December 6, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced in response to the Unusual Incident Report (UIR) received by the Department from the facility on December 5, 2024. LPA met with Wellness Coordinator (WC) Kristinia Morgan and Care Coordinator (CC) Bessy John and informed the reason for visit. UIR indicated that on December 1, 2024, resident (R1) was out with R1's family when R1 was complained of pain in the left wrist. The family took R1 to the hospital where it was discovered that R1's wrist is broken.The UIR is missing last page (page 2) which LPA obtained from CC on this same day. LPA reviewed R1's records and obtained copies of the following documents: Face Sheet; LIC602A Physician's Report; facility notes; hospital's After Visit Summary. LPA conducted interviews. No deficiency cited on this day. WC has to leave the facility and gave permission to have CC sign and receive this report. Exit interview conducted and copy of this report provided.

On 11/19/24 at 2:35 PM, Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver an amended report from the visit that occurred on 10/01/24. LPA met with Administrator, Dolly Rizvi and explained the purpose of the visit. Amended report delivered. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

On 11/18/2024 at 9:15 AM, Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Dolly Rizvi, and explained the purpose of the visit. The facility’s fire clearance was approved for ninety nine (99) non-ambulatory residents, of which nine (9) may be bedridden and approved for eighteen (18) hospice. LPA toured the facility with Wellness Coordinator Kristinia Morgan, including but not limited to residents' apartments, bathrooms, multiple activity rooms, kitchen, common area and courtyard. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in visitor bathroom was measured at 110.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medications, sharps and toxic are locked and inaccessible to residents in care. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher all around the facility was last serviced on 10/15/2024. At 10:02 am LPA reviewed 9 residents records. At 10:45 am, LPA reviewed 4 staff records and 4 of 4 were fingerprint cleared and associated to the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

S1 stated that for the protection of the staff involved the staff was reassigned to another section of the facility and that the money R1 gave the staff was a fake $100 bill. This agency has investigated the above complaint. We have found that the complaint was unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview conducted, a copy of this report provided.

Page 2 Allegation: Resident (R1) sustained fractured finger while in care. On 11/02/21, LPA Delmundo interviewed S1, S2, S4, S6, and R1. S2 stated having observed R1 had purplish discoloration at one of the small fingers that on 10/24/21, and that R1 yelled out when it was touched. S2 then had R1 transferred to hospital for evaluation. All other staff interviewed was not able to provide information as to how the injury occurred. S6 stated having observed a fresh wound at R1’s right elbow but had no knowledge of how it happened. S2 and S7 were not aware of the subject incident. S1 reported being aware that the facility’s LVN observed that R1 had swelling on one of R1’s finger. S4 only stated having knowledge that R1 was transferred to hospital due to a swollen finger. R1 reported not remembering how the wound happened and did not state that there was any staff involvement. On 8/13/24, LPA Delmundo interviewed FM, who reported being aware that R1 was sent to hospital for the finger injury; and that R1 can be combative and “out of control” and “could see” R1 causing self-injury due to the behaviors. On 11/2/21, LPA Delmundo reviewed R1’s file and observed the Physician’s report indicating a diagnosis of Dementia with Behavioral Disturbance. Based on all information gathered, the allegation is closed as 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 the evidence to prove that the alleged violations occurred. Allegation: Facility staff hit resident (R1). During complaint intake, the reporting party (RP) stated that R1 informed the RP that R1 is beaten by facility staff. The RP further stated that RP had spoken to FM, who reported being aware that R1 needed transfer to the hospital for an injury. FM further stated that R1 is “manipulative,” “delusional,” and “paranoid”; and did not believe that staff had hurt R1, but that due to aggressive behavior R1 has hurt the staff; and that R1 showed no caution for self-safety. RP stated R1 was sent to hospital via ambulance and diagnosed with right finger fracture. ....continued on 9099C (page 3) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Page 3 All 5 staff (S1-S5) interviewed denied hitting residents and stated not observing any staff hitting residents. S4 stated there was an incident when R1 twisted a spoon and scratched S4. S1 confirmed R1 was sent out on 10/2021. S2 stated R1 asked S2 to check R1’s finger and S2 observed discoloration on the left pinkie and R1 was transferred to hospital; however, R1 was discharged back to the facility without the After Visit Summary. Facility’s Internal Incident Report matched S2’s statement. R1 was not able to provide information regarding the subject incident and indicated that staff are “good.” R3 and R4 declined to be interviewed. R2 and R5 stated having no knowledge of or having been aware of staff abusing any resident. Review of R1’s records showed R1 has dementia, aggressive behavior, and behavior disturbance. LPA interviewed R1’s family member (FM) who confirmed RP and staff’s statements that R1 has agitation and behavior issues. FM stated R1 was combative and hurt herself. Based on all information gathered, the allegation is closed as 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 the evidence to prove that the alleged violations occurred. No deficiency cited. Exit interview conducted and copy of this report provided.

Allegation: Staff handled resident roughly Unsubstantiated. During the course of investigation, LPAs interviewed residents (R), staff (S), and resident family members (W). R1, R2, R3, R4, and R5, stated that they have not witness any staff rough handle any residents at the facility nor heard any of the staff rough handle any residents. S1, S2, S3 and W1 stated they have not witness nor heard any of the facility staff rough handle any residents. All individuals interviewed stated that they have not witnessed any resident's falling, any resident being rough handled or any resident being dropped on the ground. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview conducted, a copy of this report provided.

On this day at approximately 10:40 am, Licensing Program Analyst (LPA) arrived at the facility unannounced to conduct case management visit to follow up on six residents that needed immediate transfer from Montgomery Springs Manor. LPA met with Administrator Dolly Rizvi. LPA explained to Rizvi the purpose of visit. During the visit, LPA interviewed Residents 1-6. Based on interviews conducted, there are no immediate health and safety concerns noted. A copy of this report was provided to Administrator.