complaint·June 9, 2021

Interviews conducted with 1 out of 11 residents stated there is staff present in the common areas, 1 out of 11 residents stated there is not enough staff at the facility and 9 out of 11 residents were not able to answer questions due to cognitive skills. Interviews with staff; 3 out of 7 staff interview stated that there is a floor supervisor who assist the caregivers throughout the shift. 5 out of 7 staff stated that S7 was walking by when the incident happened and attempted to redirect R2. Based on interviews the incident took place near an elevator in the second floor of the facility were R2 was sitting down on chair available in hallway, S7 was walking by when incident took place and attempted to de-escalated the situation. S2, S3, and S5 who were down the hall heard and/or observed the incident and walked over to assist S7. S6 stated to be called on radio to assist with incident, S6 moved from the first floor to the second floor and observed the incident upon arriving. Documents reviewed revealed R2 was admitted to the facility on 4/23/21. R2's Individual Service Plan - Socialization states R2 "may exhibit stress or agitation transitioning to a new environment." R1 Hospital discharge document indicates assault, jaw pain. Impression: No acute traumatic injury noted. On 5/30/21 Pasadena Police department was contacted by facility, administrator stated officers did not press chargers per family member request or assisted with 5150 as R1 has a diagnosis of dementia. Pasadena police department business card was provided with police report # 21005733. On 5/30/21 facility submitted a Report of Suspected Dependent Adult/Elderly Abuse (SOC 341) via phone call. On 5/31/21 Facility mail incident report to Community Care Licensing (CCLD). On 6/8/12 family member stated to have taken R1 to the hospital to be check after the incident and there were no bruises or injuries visible. Based on LPA's documents reviewed and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED. Exit interview was conducted with Virginia Garcia, administrator a copy of this report was provided.