The resident showed clear warning signs on the evening of August 14.
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On May 2, the resident's blood sugar spiked to 185 mg/dl.
The incident at Holly Hill House exposed a pattern of incomplete investigations that federal inspectors documented during an August complaint survey.
The confrontation happened July 30 at The Bradford at Brookside when LVN J was interacting with Resident #7 about medication.
The woman, identified as Resident #23 in the August inspection report, told investigators the incident happened sometime in July.
The Valley Health and Rehab sent the resident home on August 8 with only a notice to quit form signed two days earlier.
The woman told federal inspectors at Valley View Care Center in August that call light response times stretched to 30 minutes.
The 50-microgram nasal spray had been prescribed in May for allergies, with orders for two sprays in each nostril twice daily.
On August 21, inspectors left one resident's room and returned less than five minutes later to find the air thick with cigarette smoke.
Both residents who made the complaints are cognitively intact, according to their mental status assessments.
The legal representative for Resident 97 told state inspectors she never received a phone call from the facility about the death.
Resident #1 at Country Club Retirement Center IV weighed 199 pounds on July 5.