complaint·June 6, 2025

Page 2 of 3. On 2/21/2025, R1’s responsible party (W1-W2) were interviewed. W1 stated they were unaware of R1’s fractured clavicle and concerned about R1 living at the facility. W1 and W2 stated R1 do not have any complaints or unexpected injuries at the facility. On 3/13/2025, the Department interviewed R1’s responsible party (W3). W3 stated R1 likes the facility and did not have any complaints about the facility. W3 stated there were no issues or unexplained injuries at the facility. On 2/26/2025, the Department interviewed 1 hospital staff (H1). H1 stated R1 did not have any bruises in the clavicle area and was not aware if the fracture was new or old. On 3/6/2025, the Department interviewed four facility staff (S1-S4). Four out of four staff stated on 2/20/2025, R1 was observed by facility staff to have shortness of breath which resulted in facility staff calling 911 to seek timely medical attention for R1. Four out of four staff stated they did not witness R1 falling or having other symptoms which may result in the fractured clavicle. Four of out four staff stated they did not physically abuse R1 or have not witnessed other staff abusing R1. Four out of four staff stated R1 does not have a history of self injurious behaviors and did not observe R1 scratching themselves. Four out of four staff stated R1 is able to express themselves when in pain. On 3/6/2025, the Department interviewed 4 residents (R1-R4). Two out of four residents were not able to answer or respond to the questions. Two out of two residents stated they have not seen R1 get hurt and no complaints about the facility staff. On 3/13/2025, the Department interviewed 3 staff at R1’s adult day program (D1-D3). D1 stated that R1 does not have self injurious behavior and R1 is able to express themselves in pain. Three out of three staff stated R1 did not have any falls or injures pertaining to the fractured clavicle. Three out of three staff stated they did not physically abuse R1 or witness other staff abusing R1. Based on R1’s hospital notes from 2/20/2025 through 2/26/2025, physician overseeing R1’s care in the hospital is R1’s primary care physician (MD). MD stated in three different progress notes on three different dates that the facility staff were taking care of R1 well and from outpatient clinic visits, physician has not noted any problems with facility caregivers. MD noted R1’s clavicle fracture is likely from a fall and does not suspected abuse. Page 3 of 3. Based on review of R1’s LIC 602A Physician’s Report dated 9/17/2024, R1 has a neurocognitive disorder, R1 is able to communicate needs and R1 has no history of skin condition or breakdown. Based on the interviews conducted with clients and staff and based on observation and records review, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the above allegations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited from California Code of Regulations, Title 22. Exit interview conducted with Direct Care Staff, Melanie Gavina and a copy of the report was provided.