Complaint·October 17, 2025

The investigation revealed the following: Allegation: “An adult in the facility pushed a resident in care.” Interviews conducted with R1 to R6 revealed the following: 5 out of 6 residents denied the allegation, and 1 out of 6 residents agreed with the allegation. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation. Record review of the Staff In Service Training on Personal Rights dated 05/15/2025 revealed the following: the document has staff signatures acknowledging that staff have attended the training, furthermore, the document states that staff will treat residents with “dignity.” Records review of Unusual Incident Reports for 08/2025 to 10/2025 revealed the following: there are no Unusual Incident Reports indicating that a person (e.g. staff/resident/visitor) pushed a resident in care. Observations on 10/17/2025 revealed the following: the Department did not observe residents/staff pushing residents in care. Based on the department’s interviews, observations, and records reviewed this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited. An exit interview was conducted, and a copy of this report was left with the Assistant Administrator Cesilia Torres.