Incident investigation·September 4, 2024

An unannounced case management visit was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding an incident report received by Community Care Licensing on July 30, 2024. LPA met with Executive Director (ED) Tami Ojwang and explained the purpose of the inspection. Per incident report, on July 25, 2024, Resident 1’s (R1’s) representative reported that Staff 1 (S1) text them a video and photographs of R1. Video depicted R1 engaged in a verbal altercation with Staff 2 (S2), whom had “previously been investigated” and “was counseled.” Photographs depicted S2 assisting R1 with changing clothes. S1 resigned their position on Jully 25, 2024, in the middle of their shift. During case management visit on August 9, 2024, interviews were conducted with staff and R1. During their interview, S1 confirmed they had taken the video of the verbal altercation between S2 and R1 and stated they provided the video and a written statement about the incident to former ED Jennifer Turgeon and Staff 3 (S3) on June 5, 2024. Per S1, they resigned their position during their shift on July 25, 2024 because the incident went unaddressed despite the video evidence. During their interview, S3 confirmed they were first notified of the incident and about the video in June, but stated they did not recall the exact date. S3 stated they had not watched the video and stated they did not have S1’s written statement as it had been provided to ED Turgeon. During their interview, former ED Turgeon refused to provide LPA with S1’s written statement and provided LPA with their own written and signed statement, which stated an investigation had been completed on June 19, 2024, regarding S1’s report about S2 arguing with R1. Per ED’s written statement, S2 was asked about the incident and confirmed they had yelled at R1 and called them a “thief”. Former ED Turgeon stated S2 is no longer working with R1, but continues working at the facility in another area. (Cont. LIC9099-C) An incident report was not submitted to CCL regarding the video, S1’s written statement, and/or “investigation” conducted by ED until July 30, 2024. Based on observations, deficiencies are being cited per Title 22, Division 6 of the California Code of regulations. An exit interview was conducted a copy of this report was provided at the end of the inspection.