Complaint·August 6, 2021

contusions but observed R1’s rib area was painful when touched and noted that R1 “winced” upon touch. R1’s responsible party was present at the appointment and noted this was the first time they were hearing about the incident. R1 reported S1 punched R1 three times in the ribs. R1 screamed out S1’s name after the third punch. S1 took a step back and seemed to be “dazed” at what happened. R1 stated S1 suddenly left the facility. According to R1, when Staff 2 (S2) came on shift, S2 was not happy that S1 left a mess in the kitchen. R1 reported what occurred to S2 and that S1 had suddenly left the facility. LPA obtained an incident report that includes an attached, unsigned declaration from S3. The declaration states on 11/26/2019, R1 reported to S3 that on 11/25/2019, S1 hit R1 in the ribs. S3 states R1 was checked and S3 observed no bruises or skin tears, and R1 reported no pain. S3 asked S1 about the incident and S1 denied touching R1. Credible Witness 2 and R1’s friend stated they believe R1 is credible and does not have a history of false statements. R1’s physician’s report dated 12/13/2018 and signed 1/1/2019 does not indicate R1 has any cognitive issues. Based on the information obtained, the allegation is Substantiated. Allegation #2: Staff did not report incident. Prior to conducting the initial visit on 12/31/2019, LPA reviewed CCL’s incident report log and observed no incident report(s) for R1 in November 2019, and no incident report(s) indicating S1 hit R1. LPA also observed no incident reports indicating R1 embellished other incidents. During the visit on 12/31/2019, LPA obtained a written incident report for the incident on 11/25/2019, when S1 inappropriately handled R1. Administrator could not provide any verification that the incident report was sent in to CCL. In addition, the incident report does not indicate the alleged abuse was reported to the Long Term Care Ombudsman or law enforcement. The incident report also includes an attached, unsigned declaration from Staff 3 (S3). The declaration indicates R1’s responsible party was notified of the incident. However, R1’s responsible party indicated they first became aware of the incident from R1 at R1’s physician’s appointment on 12/11/2019. Over the course of the investigation, R1 passed away. Community Care Licensing did not receive a required death report from the facility for R1’s death. Based on the information obtained, the allegation “staff did not report incident” is Substantiated at this time. At 2:41 pm, Administrator Lidia Kravchuk refused to sign Complaint Investigation Report (LIC9099, Pages 1-3. Exit interview conducted, report given, deficiencies cited on 9099-D, appeal rights provided. contusions. However, the physician observed R1’s rib area was painful when touched and noted that R1 “winced.” There was no evidence to indicate that S3 offered to have R1 evaluated by a medical professional. Although it may have been prudent for the administrator to ensure R1 was assessed by a medical professional, R1 did not report pain and S3 stated there was no visible bruising or skin tears when a body check was conducted on 11/26/2019. Based on interviews conducted, there is insufficient evidence to prove facility failed to provide timely medical attention. Therefore, the allegation is Unsubstantiated at this time. Exit interview, report given