Incident investigation·May 11, 2026

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced case management visit. Upon arrival, LPA was greeted by staff member Claudia Lizardo, to whom she identified herself and explained the purpose of the visit. During the visit, LPA observed residents in care, completed a health and safety check, reviewed facility records, and conducted interviews with staff and residents. The purpose of today’s visit was to follow up on a self reported incident. On May 11, 2026, the Department received an incident report regarding an event that occurred on May 7, 2026, at 3:00 am Resident 1 (R1) approached Resident 2 (R2) in the living room. R2 had their pull up adult brief at their ankles. R2 stated that they requested for help to get their pull up brief on and R1 helped R2 and R2 claimed that R1 touched their private parts. R2 notified Staff 2 (S2) and Staff 3 (S3) at 6:00 pm on May 7, 2026, about the incident and Staff 2 reviewed video of the time of the incident. The video footage showed R1 assisting R2 and then their head moving close to R2's private area and R2 using their hand push R1 away. S2 reported the incident to the resident's responsible parties, their PACE care teams, filed a report with APS, filed a report with the local ombudsman, and notified Community Care Licensing. There was not a police report filed. No immediate health or safety risks were observed during this visit. Additional case management will be provided for this incident, including subsequent visits and staff interviews, as needed. An exit interview was conducted, and a copy of this report and Licensee Rights LIC 9058 (03/22)  were left with the Director, whose signature on this form confirms receipt of these documents.