complaint·April 9, 2025

Interview with R1 indicated that they experienced multiple times not being treated with dignity by S1, including arguing and derogatory statements regarding R1. Interview with resident (R2) indicated that they experienced and witnessed S1 not treating the residents with dignity at the care home. On April 4, 2025, LPA received a recording in which LPA observed staff member (S2) not treating R1 with dignity, including arguing and intimidation. Interview with R1 indicated that they have felt intimidated by facility staff. Interview with Licensee indicated that they received two reports regarding S1 not treating R1 with dignity. Licensee stated that, on March 17, 2025, R1 reported that S1 was "being mean" but wasn't specific how S1 was being mean. Licensee stated that, on March 28, 2025, R1 reported that they were arguing with S1 and S1 argued back with R1 and made derogatory remarks. Licensee stated that S1 quit working at the facility that same day right after being asked about the incident. LPA received an Unusual Incident/Injury Report (SIR) dated March 31, 2025 which states that, on March 28, 2025, "Residents were at the table having lunch. R1 demanded that caregiver assists [them] immediately with a second cup of coffee, while staff was assisting other residents. Caregiver responded that when they are assisting other residents, [R1] will have to be patient and wait, if its not an emergency. Conservation escalated, and R1 started calling the staff inappropriate names." LPA obtained and reviewed a 30-Day Notice of Termination of Residency given to R1 and authored by Licensee dated March 31, 2015 and given to R1 on March 31, 2025. LPA observed two (2) of multiple reasons listed on the notice to justify termination included the following: "The 602 report did not accurately reflect the level of care required for your needs. We have found that your needs exceed the current care plan, and providing appropriate support has been a challenge...There have been repeated instances of you engaging in disruptive behavior, including outbursts and aggression when staff are unable to immediately attend to your requests." LPA obtained and reviewed R1's Physician's Report (LIC 602A) dated January 15, 2025, which indicated R1 was diagnosed with anxiety disorder and other schizophrenia, and R1 exhibits aggressive behavior including "accusatory behavior, impulsive." LPA obtained and reviewed R1's Preplacement Appraisal Information (LIC 603) dated February 4, 2025, which indicates for Health History to "refer to 602." LPA observed that the physical address and mail stop code for Community Care Licensing Office to allow the recipient of the notice to file a complaint if desired was incorrect on the notice issued to R1 on March 31, 2025. ** Report continued on 9099-C ** Based on interviews conducted, LPA's observations, and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8 and the Health and Safety Code, deficiencies are being cited on the attached 9099-D page. Exit interview was conducted with Licensee. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.