The Palms at Bonaventure Assisted Living

This report details a Complaint Investigation conducted on 09/26/2025 regarding several allegations. All four allegations—regarding low-carb food options, unkempt restrooms, lost personal items, and lack of dignity/respect—were investigated and subsequently deemed Unsubstantiated by the licensing evaluator. No deficiencies were cited in this report.

The report details a complaint investigation conducted following an initial complaint visit. All allegations cited—including communicable disease protocol, food service, pest control, dignity, and safeguarding belongings—were investigated and subsequently deemed 'Unsubstantiated' by the Licensing Program Analyst. No deficiencies were formally observed or cited in the final findings.

The investigation substantiated allegations of resident assault and unsafe resident movement within the facility. The primary deficiency cited relates to the failure to ensure safe and comfortable accommodations, specifically concerning resident safety protocols. The report indicates that the facility was found non-compliant with personal rights standards due to the incident.

This report details a complaint investigation regarding allegations of staff failing to safeguard resident funds. The investigation concluded that the allegation was Unsubstantiated at this time. Furthermore, the report explicitly states that no deficiencies were observed during the visit.

The inspection was a Case Management - Incident visit conducted to review two self-reported incidents. The report details an elopement incident and a fall incident, but explicitly states that based on interviews and records reviewed, no deficiencies were observed at this time.

This report details a complaint investigation regarding allegations of resident neglect, including pressure injuries, inadequate feeding/hydration, and leaving residents without light. All allegations cited in the report were deemed 'unsubstantiated' based on file reviews and staff/resident interviews conducted during the investigation.

The inspection identified multiple deficiencies across several critical areas, including immediate safety hazards related to fire clearance and medication storage, and general maintenance issues. Specifically, there were citations for unsecured hazardous materials, improper storage of medications, and general sanitation/maintenance concerns like pests and non-functional lights. The facility was issued civil penalties and required to submit multiple Plans of Correction by September 23, 2024.

The investigation substantiated allegations of neglect and lack of care, specifically concerning resident R1's injuries sustained during a transfer. The facility was cited for failing to meet basic services requirements related to resident transfers, which posed an immediate health and safety risk. A $500 immediate civil penalty was assessed, and the facility must submit a plan of correction for staff transfer procedures.