complaint·August 1, 2025

Interview with S2 revealed that at around 10pm, R1 proceeded to ask S1 for pizza again, and S1 declined his request. At this time R1 became more verbally aggressive and S1 clocked out of their shift and went outside. According to Staff 2, minutes later, S1 came back into the building and told S2, “I hit him”, referring to R1. Interview with lead MedTech revealed that S1 told MedTech that R1 hit S1 so S1 hit them back. On May 14, 2023, emergency personnel interviewed S1 who revealed that during the incident, R1 swung at S1, S1 dodged the attempted hit then struck R1 with an open right hand to the nose in self-defense, which cause R1 to fall to the floor. Medical records collected revealed that on May 14, 2023, R1 was admitted to hospital due to facial trauma and diagnosed with a nasal fracture. On June 1, 2023, S1 was interviewed by the Department. S1 stated that they were being assaulted by R1, and in self-defense put out right arm, which cause R1 to hit nose on S1’s arm. Interview with another resident revealed that S1 has a history of verbal outbursts towards residents in care. Based on interviews conducted, review of records, including outside sources records, a preponderance of evidence exists to support the allegation that staff assaulted resident in care, resulting in serious injury. The allegation is therefore substantiated. A deficiency is cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). The Department has determined this violation resulted in injuries to the resident in care.  An immediate Civil Penalty is being charged and is noted as a duplicate violation within 12 months, therefore it is assessed as $1,000 on the LIC421IM.  Currently, per Health and Safety Code Section 1569.49, an additional civil penalty assessment is under review by the Program Administrator of Community Care Licensing Division. An exit interview was conducted with Clinical Director Yolanda Torres, and a Plan of Correction was jointly developed. A copy of this report, LIC811, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to Clinical Director Yolanda Torres, signature on this form confirms receipt of documents.