Incident investigation·February 13, 2024

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Rod Moshiri, Administrator. The purpose of the visit was to address an incident that occurred on 01/07/2023 and was self-reported by the facility via SOC341 Suspected Adult/Elder Abuse Form and LIC624 Unusual Incident/Injury Report (UIR) on 01/09/2023. The incident involved an unauthorized male who entered the facility through a side exit door that had been propped open. The unauthorized male proceeded to enter the facility, entered into resident R1’s living unit, and sexually assaulted R1. The incident was investigated by the Department beginning on 01/11/2023 and the Department conducted interviews with staff, residents, and witnesses and reviewed records. During interviews, staff stated the side exit doors are used and held propped open to allow easy access to and from the facility. The side exit doors are supposed to be used only if there is a fire. All residents are to use the main entrance and not the side exit doors. Side exits are to be shut, latched, and always locked. Interviews with multiple residents revealed that residents at BridgePoint at Los Altos would open the exit doors to keep the exit doors from locking. The local Police Department (PD) investigated and created an investigative report. R1 disclosed that the unauthorized male got on top of R1, “humped” R1, and used his fingers to rub R1’s genitalia. Resident R2 told PD officers that R2 observed the unauthorized male and told staff of the unauthorized male’s presence, but staff ignored R2 multiple times. Deficiencies were cited as per California Code of Regulations Title 22. See LIC809-D page for more information. This report was reviewed with Administrator Rod Moshiri and a copy of this report and appeal rights were provided.