complaint·November 6, 2025

Prior to R1’s surgery for the fracture, doctors had difficulty inserting a catheter due to swelling in the vaginal area which could be due to incontinence. Per the hospital medical records, a large hematoma formed in R1’s groin area and was suspected to be caused by the fracture or possible sexual abuse. R1’s family filed a police report on the evening of June 15, 2025. Due to the delay in reporting the incident and the resident’s condition, R1’s family declined to consent to a sexual abuse exam. Interview with R1’s family indicated a family member was usually at the facility during incontinence care to supervise. The department attempted to interview R1 but was unsuccessful due to cognitive decline. One out of one memory care residents denied any abuse occurring at the facility. On June 15, 2025, Orange County Sheriff’s office conducted a visit to the facility to investigate the allegation. Through interviews, records and video surveillance, the detective determined that a sexual assault had not occurred, and the resident’s family concurred with the detective. The case was closed OC Sheriff’s office. The Department interviewed facility staff as well as obtained written statements from staff at the facility. Four out of four staff interviewed and eight out of eight statements by staff deny any sexual abuse occurring at the facility. Based on interviews conducted, the Department is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Administrator Westphaln and a copy of this report was provided to facility.