Complaint·January 11, 2024

In an interview, S1 said the incident did not happen as described by R1. S1 described the incident only as a verbal conversation. In an interview, R5 said he had not seen S1 threaten R1 with a knife. R2, R3, and R4 had not witnessed staff become threatening or aggressive with clients. The department has determined the following as it relates to the allegation that a staff member threatened a resident while in care: Based on interviews, the above allegation is UNSUBSTANTIATED, which means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiencies were cited regarding the above allegation. An exit interview was held and a copy of this report was left with Jack. In interviews, S1 said that R1 often told her that he wanted to kill himself. “You always want to kill yourself. When you’re ready, let me know,” S1 said while recounting the incident described by R1. S1 said that she also informed R1 that the form of self-injurious behavior he was engaging in was not a sufficient way to kill oneself. S1 said that, after R1 asked if she would visit him after he died, S1 said nobody would visit him after he was cremated. S1 said that she and R1 took the discussion as a joke. S1 also said that, during an unrelated incident on or around December 5, 2023, she “yelled” and/or “shouted” at R1 because R1 was seeking attention from her. “Grow up and stop seeking attention,” S1 said while recounting the incident. In an interview, R2 said there are a few staff members who yell at residents when they are frustrated. R3 said staff get upset with him and sometimes yell at him. R4 had overheard arguments between staff and R1. R5 said S1 does not talk to people, but rather “barks at them.” R6 said staff do not treat her with respect. The department has determined the following as it relates to the allegation that a staff member did not treat a resident with dignity and respect: Based on interviews, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met. This facility is being cited per 22 CCR Section 87468.1(a)(1). An exit interview was held and a copy of this report was left with Jack.