complaint·February 17, 2026

Allegation: Staff preventing residents from getting personal belongings. It was alleged R1 requested a sweater from staff member S1 and was denied. It was further alleged that R1’s closet is locked due to R1 removing clothing and creating a mess. It was also alleged that other residents have locked closets while some residents do not. The report alleges staff are preventing residents from accessing their personal belongings. During resident interviews, most residents (R2–R7) reported that their clothing is kept in their closets and stated that their closets were not locked. None of these residents reported that staff had told them they could not have their clothing or personal items. When asked whether they had concerns about staff preventing access to belongings, most residents were unable to answer. Several residents demonstrated limited ability to respond to questions, which appeared consistent with cognitive impairment. R1 reported that her closet is always locked and stated that she cannot access her clothing whenever she wants. R1 reported that staff sometimes assist her in accessing her clothing when she asks and stated that staff have sometimes told her she could not have her belongings. R1 stated that she feels “sad” when she is unable to access her belongings. R1 appeared consistent with cognitive impairment. During staff interviews, staff consistently reported that some residents’ closets are locked due to safety concerns related to cognitive impairment, including residents removing all items from closets, attempting to leave the facility with belongings, or misplacing items. Multiple staff indicated that these behaviors are frequently associated with R1 due to confusion and dementia-related behaviors. Staff generally stated that the decision to lock a resident’s closet is made or approved by administration; however, some staff reported that there was no specific directive and that staff act based on familiarity with resident behaviors. Staff reported that keys to locked closets are accessible to staff, including medication technicians, and that all staff are aware of the combination codes for coded locks. Staff stated that residents may request staff assistance to access their belongings. Several staff reported that they had not observed staff denying residents access to their personal belongings when requested. Staff were unsure whether restrictions on personal belongings are documented in resident records. During the visit, LPA observed resident R1’s closet to be locked. LPA also observed six (6) additional resident bedrooms with closet locks present, some of which were in use or broken. LPA observed that some residents’ closets were locked while others were not. LPA did not observe any posted signage or written notice explaining restrictions on resident access to personal belongings. The LPA reviewed R1’s admission agreement, assessments, and care plan and found no documentation authorizing restrictions on access to personal belongings. S1 confirmed no such documentation existed and stated that no waiver to lock resident closets had been requested to Licensing. No physician order or written consent was observed, and facility policies did not clearly authorize locking resident closets. The LPA attempted to contact the assigned ALW Coordinator and social worker but was unable to make direct contact and left a message with the ALW receptionist. Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.