complaint·September 18, 2025

explained to the administrator that they could not do that to the resident even if the resident was a fall risk. The witness explained to the administrator that there were other ways to prevent falls and thought it was dangerous for them to put any kind of restraint on residents. They offered the facility a bed alarm but reminded them that they still need to keep a close eye on R1 especially since the resident was the only resident at the facility at the time. Per another witness LPA interviewed, the witness saw the restraint placed on R1 when they were sitting on the lazy boy chair in the living room. The witness said it was just briefly that R1 had a restraint. The witness said it was not a rope or anything of a hard restraint. The witness thought the restraint was a reminder to prevent R1 from falling. The witness felt the facility cared about R1. Per interview with Administrator Kevin Dinh, he admitted that a physical restraint was placed on R1 because he was a fall risk due to his health diagnosis and condition. He said they had placed the restraint around R1 but it was loose not tight at all. He said R1’s family was okay with it. He explained that the family thought it was a great idea with the restraint and appreciate it. At the time of initial visit, LPA observed the resident to have no physical restraints on them. The facility was provided a bed alarm for the resident by the hospice agency to detect any movements to prevent falls. A few days later after LPA's initial visit, R1 moved to another facility. Therefore, based on LPA Tea's observations and interview conducted, the allegation that staff is restraining a resident in care is determined to be SUBSTANTIATED, meaning the complaint allegation is valid and that a violation has occurred. The following are being cited per California Code of Regulations Title 22 Division 6 Chapter 8. An exit interview was conducted with Administrator (AD) Kevin Dinh and a copy of this report and appeal rights was provided to the facility. **THIS IS AN AMENDED REPORT**