Incident investigation·May 28, 2025

On May 28, 2025, Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Case Management – Incident inspection visit regarding a reported staff-to-resident physical abuse incident that occurred on 05/17/2025. The facility also reported SOC 341 for the same physical abuse incident. Upon arrival, the LPA was greeted by the Executive Director (ED), Li Li. The LPA disclosed the purpose of the visit. LPA interviewed ED and Resident R1. ED stated that on 05/17/2025, at 8:00 AM, Caregivers S1 and S2 were assisting a R1 in R1’s room during the AM shift. R1 was combative and agitated. R1 was hitting caregiver S1 on the arms, spitting on S1's face, and kicking S1 with their legs. S1 inappropriately slapped R1’s arm and tapped R1’s mouth using threatening language. S2 reported the incident to S4. Charge Nurse S3 assessed R1 and conducted a full body exam, finding no areas of redness, or discoloration, and no painful or tender areas. No injuries were noted. S1 was suspended and removed from the community. The incident was reported to S4, who was the manager on duty. Upon reviewing the situation, S4 immediately suspended S1 and escorted S1 off the community. S4 contacted the R1’s responsible party (RP) to inform them of the incident. R1’s Primary Care Physician (PCP) was notified of the incident on 05/20/2025. ED stated S1 was officially terminated yesterday, 05/27/2025. R1 have been on alert charting. R1 is fine, calm at baseline and was on frequently safety checks. ED further stated that Palo Alto PD was called on 05/22/2025, but no police has showed up, but there was a phone interview and R1’s and S1’s personal information was taken. Continued on LIC809-C RP was called on 05/17/2025 and RP had no concerns. ED followed up with RP over the phone again on 05/27/2025 to give update on R1. ED stated they will continue with elder abuse, resident’s rights, and policies of workplace violence prevention for California training for facility staff members. LPA conducted a wellness check on R1 by visiting their room. R1 was observed to be watching TV, closing his eyes often, and answered LPA questions by verbally responding and nodding. R1 stated he had no pain and doesn’t remember anyone tapping his mouth or slapping his arms or spitting on their face. R1 further stated no one used foul or threatening language with them. No deficiencies were cited during today's visit. An exit interview was conducted with the Executive Director. A copy of this report was left with the Executive Director, Li Li, whose signature on this form confirms receipt of the report.