complaint·October 24, 2025

Interview conducted with R1 indicated that they are being disrespected by residents and care staff at the care home. R1 stated that they have been called names, such as an "old hag," by resident (R2). Resident stated that they were grabbed by R2 on the arm along with care staff (S1). R1 stated that R2 and S1 tried to force R1 into their room. R1 stated that R2 and S1 were unsuccessful in forcing them back into their room after resisting. R1 stated that they contacted local law enforcement regarding the incident. R2 denied physically assaulting R1 during incident on June 6, 2025. R2 denied anyone, resident or staff, assaulting R1 on June 6, 2025. R2 stated that they did have a verbal altercation with R1 on June 6, 2025, including getting in R1's face and telling R1 to go to their room. R2 claimed that R1 has violated their personal rights on multiple occasions. Interview with resident (R3) and Administrator confirmed that there have been verbal altercations between R1 and R2 at the facility. R3 stated that R1 and R2 have yelled at each other, but have never physically assaulted each other. R3 stated that they witnessed incident on June 6, 2025, and stated that neither R2, nor S1, physically assaulted R1. R3 confirmed that R1 tends to violate other residents' personal rights. Administrator stated that they did not witness incident on June 6, 2025. Administrator stated that R1 tends to start conflict with the other residents. Administrator will redirect residents when they initiate verbal altercations between each other. LPA contacted local law enforcement for records and information regarding incident on June 6, 2025. LPA spoke with local law enforcement representative via telephone call, who stated that no police report was completed regarding incident. Local law enforcement representative stated that there was a "disturbance" at the facility on June 6, 2025, but no crime was found to be committed. Local law enforcement representative stated that caregiver on site did not witness any physical altercation between residents on June 6, 2025. LPA reviewed R1's Admission Agreement, including house policies. LPA did not observe any house policies established in admission agreement regarding personal rights and residents treating others with dignity and respect. Based on interviews conducted and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.