complaint·April 30, 2026

The investigation revealed the following: Allegation: “ Staff do not prevent resident from not treating residents with dignity and respect .” Interviews conducted with R1 to R9 revealed the following: 5 out of 9 residents agree with the allegation; 3 out of 9 residents denied the allegation; 1 out of 9 residents indicated that they have heard a resident use profanity but were unsure if staff intervened (because they were in their room and could not see the incidents). Interviews conducted with S1 to S4 revealed the following: 3 out of 4 staff indicated that they ignore R1 when they are verbally aggressive toward other residents; 2 out of 3 staff indicated that they do attempt to de-escalate R1 when they are verbally aggressive toward other residents by talking to R1 in a calm voice and telling other residents to go to their rooms; 1 out of 4 staff indicated that they have not witnessed residents being verbally aggressive toward other residents. The Administrator indicated that they have not trained staff on R1’s care plan for de-escalation. R1’s California Assisted Living Waiver (ALW) Program Individual Service Plan (ISP) dated 11/18/2022 revealed the following: “Socialization: Participant at risk for episodes of verbal aggression towards other residents and staff…Interventions/Plan: RCFE staff to use thoughtful and careful redirecting as needed to diffuse aggressive/inappropriate social behavior.” R1’s Medical Documents dated 03/11/2026 revealed the following: “Chief complaint:..Concerns: responds to internal stimuli (talks to self), verbal aggression/profanity toward self/staff/residents…” R1’s Medical Documents dated 04/22/2026 revealed the following: it indicated that R1’s “baseline” remains the same. Observations on 04/30/2026 revealed the following: R1 used profanity in a very loud voice; according to S1 and S4 R1 was in their room talking to themselves. Staff trainings revealed the following: staff have been trained on resident rights and behavioral expression management. Based on observations, interviews and record reviews, 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 8 are being cited on the attached LIC 9099D. An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Administrator, Zuo Fen Hauf.