St Matthew's Home for the Elderly III

Allegation investigated: Resident sustained bruises due to neglect or physical abuse

***This licensing report supersedes the previous licensing report dated 05/21/26 in order to clarify information obtained during the complaint investigation. The investigation findings will remain the same*** On 05/21/26, Licensing Program Analyst (LPA ) Vaid conducted an unannounced visit for the above-mentioned complaint, met with Administrator Barbara Boiston and explained the reason for the visit. LPA Vaid and Administrator toured the facility and did not observe any health and safety concerns. During the 05/21/26 visit, LPA Vaid conducted interviews with three (3) staff and six (6) residents and three (3) witnesses. LPA Vaid requested and reviewed the following document: Resident 1 (R1) face sheet/ID, physicians report, medications list. Staff and resident rosters. R1’s Home Health Agency contact information. On today’s visit, LPA Vaid met with Administrator Bioston, toured the facility and observed no health concerns. Regarding the allegation: Resident sustained bruises due to neglect or physical abuse. It is alleged that a resident sustained bruising to lower leg and left side of resident’s body, due to staff neglect or physical abuse. CONTINUED ON 9099C....... Unsubstantiated ***This licensing report supersedes the previous licensing report dated 05/21/26 in order to clarify information obtained during the complaint investigation. The investigation findings will remain the same*** Three (3) of three (3) staff interviewed deny this allegation. Staff stated that staff do not physically abuse or neglect the residents in care. Staff stated they are proactive with the resident’s care and tend to residents’ needs and services daily. Staff stated some residents have unsteady gaits and often bump into furniture and sustained bruises on their person. Staff stated reporting to R1’s physicians and family of the incidents of severe dizziness and muscle cramps causing R1 to involuntarily cause injury to themselves. Staff stated they escort each resident to the family /activity areas in the morning and assist residents with using their walker and provide walking assistance to residents when needed. Interviews with five (5) of six (6) residents could not corroborate the allegation. Residents stated they are unaware of residents being abused or neglected in the facility. One (1) of six (6) residents stated they are not being neglected or abused by the staff and that the resident is experiencing weakness using the walker and when transferring from bed to wheelchair. The resident stated feeling too weak to walk unassisted and has experienced bruising due to fragility of the skin. Interviews with R1 revealed that R1 is not being neglected or abused by staff. LPA observed R1 had no bruises on R1’s lower leg and left side of R1’s body. Review of R1s medical records show that R1 is prescribed medications that make R1 dizzy and experience muscle fatigue. The majority of R1’s prescribed medications are known to cause dizziness, muscle cramping, and light-headedness, which may contribute to R1 injuring themselves. Review of R1’s physician report dated 03/06/2026, indicates that R1 has history of skin breakdown, and pressure induced deep tissue damage causing bruising to R1. R1’s Primary Physician is aware of R1’s physical condition and R1’s susceptibility to weakness and dizziness caused by the interactions of R1’s prescribed medications, which have led to R1 striking a surface and bruising to R1. R1 is not receiving Home Health services, due to R1’s family stopping R1’s Home Health services as of 04/09/2026. The investigation did not reveal that staff are neglecting and/or physically abusing residents in care. Based on records review and interviews conducted, 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 was held and copy of this report was provided to the Administrator, Barbara Bioston.the state’s words, verbatim · CDSS document, Aug 3, 2026 · control 28-AS-20260515084922

Allegation investigated: Resident sustained bruises due to neglect or physical abuse

Licensing Program Analyst (LPA ) Vaid conducted an unannounced visit for the above-mentioned complaint, met with Administrator Barbara Boiston and explained the reason for the visit. LPA Vaid and Administrator toured the facility and did not observe any health and safety concerns. LPA Vaid requested and reviewed the following document: Resident 1 (R1) face sheet/ID, physicians report, medications list. Staff and resident rosters. Home Health agency contacts information. Regarding the allegation: Resident sustained bruises due to neglect or physical abuse. It is alleged that a resident sustained bruising to their body due to neglect or physical abuse by the facility staff. Three of three staff interviewed deny this allegation, staff stated they are proactive with the residents in their care and tend to their needs and services daily. Staff stated some residents have unsteady gaits and often bump into furniture and sustained bruising on their person. CONTINUED ON 9099C............... Unsubstantiated Staff stated reporting to physicians and family of the incidents of sever dizziness and muscle cramps causing residents to involuntarily cause injury to themselves. Staff stated they escort each resident to the family /activity areas in the morning and assist residents with using their walker or providing walking assistance when needed. Five of six residents could not corroborate with this, residents stated they are unaware of this happening. One of six residents stated they are not being abused by the staff and that the resident is experiencing weakness using the walker and transferring from bed to wheelchair, the resident stated feeling too weak to walk unassisted and has experience bruising due to fragility of the skin. Medical records show that R1 is prescribed medications that make R1 dizzy and experience muscle fatigue. Majority of the medications R1 are prescribed are known to cause dizziness, muscle cramping, and light-headedness causing R1 to injure themselves. Review of R1’s physician report dated 03/06/2026 has history of skin breakdown, and pressure induced deep tissue damage causing bruising to the resident. Primary physicians are aware of residents’ physical condition and residents’ susceptible to weakness and dizziness caused by the interactions of the prescribed medications that has led to a resident striking a surface and bruising their body. R1 does not receive home health, R1’s family has stopped using home health agency as of 04/09/2026. Based on records review and interviews conducted, 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 was held and copy of this report was provided to the Administrator, Barbara Bioston.the state’s words, verbatim · CDSS document, May 21, 2026 · control 28-AS-20260515084922

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Vaid conducted an unannounced licensing annual inspection. Residential Care for Elderly to serve residents for age 60 and above. The LPA met administrator Barbara Boiston. The approved capacity is six (6) non-ambulatories. Facility has an approved Dementia Care Plan. Hospice waiver is approved for six (6). Fire clearance was granted for six (6) non-ambulatory and zero (0) bedridden. Fire clearance and Dementia care plan are in place. Auditory devices are installed at all exits and operable. Bedroom#1 and #3 are approved for one (1) non- ambulatory in each room. Bedrooms #2 and #4 are approved for two (2) non- ambulatories in each room. Today’s visit consisted of staff and residents’ interviews, LPA inspected medications, food supply, toured the physical plant, reviewed resident/staff files. The property is a single-family residence located in a neighborhood, consisting of four (4) bedrooms, two (2) full bathrooms, one (1) half bathroom, kitchen, dining room, living room with TV, laundry room, family room, and attached garage used for storage. Passageways, walkways and patios are free from obstructions. The entrance and side areas are free of hazards and debris. Garage is not accessible to residents. Bedrooms have nightstands, adequate lighting, adequate closet and drawer space. Toilet, wash basin, bathtub/shower in bathrooms are operable. Grab bars are maintained for each toilet, bathtub and shower. Adequate supply of linen, wash clothes and towels are observed. Knives, cutlery and other sharp kitchen utensils are stored in a locked cabinet in the kitchen and inaccessible to residents. Food supply consists of two days of perishable and two weeks of non-perishable was observed. Medication cabinet is locked and inaccessible to residents. First aid kit first aid manual from American red cross was available for staff use and inaccessible to residents. CONTINUED 809C.... Dual smoke/carbon monoxide detectors are tested and operable. Poisons, toxins, and cleaning supplies are locked and inaccessible to residents. Shaded area in back yard observed. Water temperature measured at 105–120-degree F. Fire extinguishers were observed and fully charged. No bodies of water are located at the facility. Administrator certificated expires 9/06/2026. No deficiencies were observed during todays visit. This report was provided to Administrator Barabara Boiston.the state’s words, verbatim · CDSS document, Nov 20, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Tao conducted an announced pre-licensing inspection. Applicant is applying for Residential Care for Elderly to serve residents for age 60 and above. The current applicant’s licensee is St. Matthew’s Home of the Elderly. The facility was previously licensed to St Francis Home for the Elderly III -198601667. The LPA met with Terry McGee, applicant/ administrator and Barbara Boiston, house manager. The requested capacity is six (6). Facility has an approved Dementia Care Plan. Hospice waiver is approved for six (6). Fire clearance: Fire clearance was granted on 08/15/24 for six (6) non-ambulatory and zero (0) bedridden. Fire clearance and Dementia care plan are in place. Auditory device is installed at all exits and operable. Bedroom#1 and #3 are approved for one (1) non- ambulatory in each room. Bedroom #2 and #4 are approved for two (2) non- ambulatory in each room. Garage in not approved for residents or staff residence. Structure: The property is a single-family residence located in a neighborhood, consisting of four (4) bedrooms, two (2) full bathrooms, one (1) half bathroom, kitchen, dining room, living room with TV, laundry room, family room, and detached garage. Passageways, walkways and patios are free from obstructions. The entrance and side areas are free of hazards and debris. Garage is not accessible to residents. (- Continued on LIC 809 C -) Bedrooms and Bathrooms for Residents: Bedrooms have nightstand, adequate lighting, adequate closet and drawer space. Bedrooms are spacious and allow for easy passage between and comfortable for usage. Toilet, wash basin, bathtub/shower in bathrooms are operable. Bedrooms are accommodated for residents. Grab bars are maintained for each toilet, bathtub and shower. Linens & Hygiene Supplies: Sufficient linen/supplies which include pillowcases, mattress pads, blanket and bedspreads are available. Adequate supply of linen, wash clothes and towels are observed. Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Dishwasher in kitchen properly installed and functioning. Knives, cutlery and other sharp kitchen utensils are stored in a locked cabinet in the kitchen and inaccessible to residents. Food supply consist of two days of perishable and two weeks of non-perishable was observed. Medications, First-Aid Kit & Book: Medication cabinet is installed with a lock and inaccessible to residents. First aid kit has a thermometer, tweezers, scissors, antiseptic, bandages, and gauze. First Aid manual from American red cross was available for staff use and inaccessible to residents. Smoke Detectors: Dual Smoke /carbon monoxide detectors are tested and operable. They are located in hallways and each bedroom. (-Continued on LIC 809 C -) Appliances: Stove burners, oven, microwave, washer, and dryer working. There are two refrigerators, located in the kitchen and garage. Each refrigerator has a measured temperature of at least 45 degrees Fahrenheit for appropriate food storage. Freezer is at (0) zero degrees Fahrenheit. The residence is equipped with central air and heat. Toxins: Poisons, toxins, and cleaning supplies are locked and inaccessible to residents. They are stored separately from food source. Emergency Phone Numbers, Exit Plan, Signages and posters: Emergency Disaster Plan and Labor law poster are posted. Exit Plan are available for review. Outdoor activity area in backyard: Outdoor activity area is furnished with chairs and table and in compliance. Shaded area in the backyard at the outdoor activity area is provided. Residents & Staff Files: Locked cabinets for records of staff and residents are installed and available. Residents file are observed. Applicant will not handle cash resources for residents. Water Temperature: Tested at 111.6 degrees Fahrenheit. Menu and phone: Menus are available for review. Free landline telephone is available for residents’ use and operable. (- Continued LIC 809 C -) Fire extinguishers: Fire extinguishers are available in the facility. They are fully charged. Reading Material, Games, Equipment & Materials: The facility has recreational materials for the residents’ use and commensurate with the plan of operation. Pool: No bodies of water located at the facility. Finding: No issue was observed during today’s visit. Exit: Exit conference was conducted. Component III orientation was conducted during this visit. A copy of this report was provided to applicant. LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, s/he has been instructed to communicate with the CAB Analyst who assigned to his/her application.the state’s words, verbatim · CDSS document, Oct 25, 2024