Complaint·December 17, 2025

(Continued from LIC9099 p.1) While the internal investigation confirmed that a bruise did exist for R1, the origin and timing of when the bruise occurred came in to question. The internal investigation did not confirm that R2 caused the bruise, as information provided by R1 was inconsistent and they could not recall details surrounding the incident. Staff consistently stated that R2 was not a problematic resident and had never been accused of physically harming another resident before this incident. While the internal incident was inconclusive regarding what caused R1's bruise, both residents were counseled to be respectful of each other's personal space. Resident interviews did not corroborate the allegation. Three (3) attempts were made to interview R2 among two (2) facility visits, without success. R1 confirmed that they were friends with R2; R1 could not recall the details of the situation that resulted in the bruise. R1 stated that staff were helpful at the facility when they needed assistance, and did not express concern regarding supervision at the facility. An outside source from an advocacy organization who was familiar with the facility and the incident was interviewed. The outside source confirmed that they checked on both residents involved in this incident and did not have concerns regarding staff supervision at the facility. The outside source informed that many residents at this facility dealt with psychiatric issues, and verbal conflict regularly occurred. This outside source informed that they attended all Resident Council meetings and no supervision issues have been brought up. Facility records showed that staff completed an internal incident report regarding the situation, and that the administrator conducted an internal investigation. The documents showed that staff took action when made aware of the possible physical abuse, and elevated the situation. Records additionally showed that staff were aware of residents' baseline conditions, as staff noticed the bruise on R1's hand, inquired about it, and elevated it for follow-up. This evidences that the staff were monitoring residents during the timeframe of the incident. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator Rocio Granda, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.