complaint·April 19, 2022

In regards to the allegation: “Resident was sexually assaulted by another residents in care”. The department interviewed administrator, current and staff #24, resident #1 to #6, witnesses and resident family members, review client records and Los Angeles County Sheriff's Department report #020-06398-0878-444. The investigation revealed information from staff #24 and resident's family who personally witnessed many of the actions and behaviors of resident #7. Former staff members reported seeing resident #7 touch, fondle and rub female residents on their breasts and vaginal area. Resident #7 was found in another resident's room while resident #7 pants were down and resident #7 was also found in the bed of a female resident and was caught taking a female dementia resident to the back area of the facility. Resident #7 also attempted to sexually assault a female resident while under the influence of a substance. Despite, staff #24 being aware of resident #7 inappropriate sexual actions and behaviors with facility residents, no substantive action was taken by staff #24 to stop resident #7 behaviors and facility residents continued to be victimized by resident #7. In regards to allegation, "Resident was exposed to scabies while in care" it was alleged a few residents had scabies at the facility. It was also alleged staff was not notified or given proper instructions on handling contagious residents. Records reviewed revealed Resident #9 was diagnosed with scabies on 8/25/2020 and Resident #10 on 09/21/20. Interviews with staff revealed that they were never trained on how to handle residents with scabies. Staff #24, who worked as the former administrator stated that Resident #3 and Resident #8 did in fact have scabies. Per Staff #24, both residents were roommates. Interviews with staff stated that Resident #9 had scabies first and later gave it to Resident #3. Per staff #24, hospice agency said it was not scabies and later determined that it was. The facility did not report scabies to Community Care Licensing. former administrator stated the Licensee, staff and families were notified of the outbreak. During the 04/13/21 site visit, LPA Almaraz received documents indicating that the Los Angeles County Public Health was being notified and a case was being opened. Based on records reviewed, evidence, and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Deficiencies cited under California Code of Regulations Title 22. Immediate civil penalties of $500 is being issued with appeal rights. "The licensee was informed that a civil penalty might be assessed based on health and safety code 1569.49 (e)or (f), or 1548 (e) or (f), 1568.0822(e) or (f)." Exit interview conducted with Elvira Cortez (Activity Director)and a copy of this report and appeal rights provided.