Incident investigation·July 7, 2023

Licensing Program Analyst (LPA) Angel Ascencio conducted a Case Management - Incident visit to the above facility. LPA Ascencio met with Administrator/Director of Resident Care Services (DRCS) Joyce Aquino at 09:25 a.m. On 07/06/02023, LPA Ascencio received a call from DRCS Aquino, at 06:03 p.m. regarding an incident that occurred on 07/05/2023, between a Memory Care resident, Resident #1 (R1), Staff #1(S1) and S2. Additionally, DRCS Aquino submitted an Unusual Incident Report and a SOC 341 Elder Abuse Report to Community Care Licensing (CCL), Adult Protective Services (APS), Long Term Care Ombudsman (LTCO) and Local Authorities. Per reports, on 07/05/2023, at approximately 09:30 p.m., R1 was being assisted with toileting needs by S1, S2 and S3. During this time, R1 was resisting and refusing toileting assistance, S1 proceeded to grab the soiled adult brief from the trash can, wave it at a very close proximity at R1's face and began to tell R1 " Look, this is what we just took off from you." S1 and S2 began to laugh at the situation while R1 moved their face away from the soiled adult brief yelling "Stop." Because S3 witnessed the actions of S1, S3 communicated the events to their direct supervisor the follow day on 07/06/2023. During today's visit, DRCS Aquino provided LPA Ascencio with written statement from S1, S2 and S3 confirming and admitting what happened the night of 07/05/2023. Interviews with S1, S2 and S3 could not be conducted as staff members are currently placed on a temporary suspension pending an internal investigations. Later that same day, an attempted interview with R1 was conducted at 10:43 a.m. R1 is a Memory Care resident with a Diagnosis of Parkinson's and Dementia. R1 could not recall incident on 07/05/2023. Continued on LIC 809 - C Additional interviews with Memory Care residents indicated that the caregivers are nice, professional and that they have not have any problems, while interviews with staff members indicated the process of how to report abuse if observed. 1 citation was issued during today's visit. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted. A copy of the report and appeal rights were provided.