The resident at AVIR at Lancaster hadn't received monthly statements since July 2025, federal inspectors found during a November complaint investigation.
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The Director of Nursing told inspectors on November 5 that the facility only made phone calls to let families know their loved ones were being moved.
Her certification expired while she continued working on the floor caring for residents.
AS 1 had been supervising Resident 1 in the Activity Room when her shift ended at 5:00 PM.
The resident had slipped out of Sunset Home's memory care unit early in the morning, triggering a Code Purple missing resident alert.
The altercations at Oakland Manor involved the same resident striking two different people.
Staff described recent resident-to-resident incidents and expressed fear about providing care to at least one particular resident.
The violation occurred during hygiene care for a resident with severe cognitive impairment at Regents Park at Aventura on November 5.
The facility filed the federal abuse report on October 1st.
The intervention was added to her plan on February 17 after her first fall.
LVN A entered the room at 11:59 AM and performed the wound treatment without donning the mandatory gown and gloves.
The violation occurred even though facility policy required care plans to address all services needed to maintain residents' physical well-being.