complaint·May 18, 2023

S2’s Internal Incident Report states while making rounds with S1, S1 began to pull R1’s comforter back while R1 was still on the bed. S2 described the way S1 pulled the comforter as “very rough.” S2 stated that S1 and S2 then went to R2’s bedroom. There, S1 began pulling on R2’s jeans while they were still buttoned on R2. S2 stated to have observed R2 to look as if R2 was in pain while S1 was pulling on R2’s jeans. S2 then told S1 that that was not the correct way to pull down the jeans but S1 ignored S2 and said the resident was fine. S2 then stayed with R2 to check on the resident and then reported the incidents to S2’s supervisor, S4. S3’s Internal Incident Report states that S1 grabbed R1’s blanket and tossed R1 over and yanked on R1’s pants to take them off. S3 states S1 then went to R2’s room and yanked on R2’s yellow blanket. Then, S1 yanked on R2’s pants without unbuttoning R2’s pants. S3 stated S2 told S1 to unbutton the pants because S1 was hurting R2. S4’s Internal Report states that S4 observed S1 pulling on R2’s jeans. During interviews, S1 stated that R1 and R2 were not properly placed on their draw sheets by the morning shift staff, so S1 did not attempt to turn over R1 and R2. S1 stated to have not pulled on R1 or R2's pants and that S2 already had denim pants pulled down R2's waist when S1 arrived. During interviews, S2 and S3 stated to have observed S1 pull on the blankets that R1 and R2 were resting on to turn them over. S2 and S3 stated to have observed S1 pulling on R1’s and R2’s pants to check them during rounds. S2 and S3 stated that S1 pulled on R2’s pants while they were still buttoned. Based on records review and interviews, there is preponderance of evidence to prove the alleged violation did occur. Therefore, the allegation is substantiated. See 9099-D for deficiencies cited per the California Code of Regulations, Title 22. This report was reviewed with Karen Lerner and a copy of the report and appela rights were provided. S3 stated during interview to have not observed any bruising on R1 or R2. S5’s written report from 05/09/2023 states that there is a “noted discoloration on left lower posterior leg” of R1. During interview, S5 stated to have not observed S1 when S1 was conducting rounds and checking on S1 and S2. Based on information from interviews conducted with staff, and records reviewed, although the allegation listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore the allegation is unsubstantiated. No Deficiencies cited under California Code of Regulations Title 22 This report was reviewed with Karen Lerner and a copy of the report was provided.