complaint·August 11, 2023

On 05/07/2021, the Department interviewed the prior Executive Director (PED). PED stated during a transfer, R1 became excited and anxious, threw himself/herself onto the chair, and obtained bruises on R1's forearm. PED also stated R1 has resisted care before, and usually moves around during transfer. On 8/11/2023, around 10:50AM, LPAs interviewed ED. ED stated ED knew R1 at another facility. ED stated R1 was easily get excited and moved around the two hands. ED stated R1 obtained bruise during transfer at another facility. On 8/11/2023, around 11:30 AM, LPAs interviewed S1. S1 stated R1 needed two care givers to move/transfer, S1 stated R1 resisted during the care or transfer. S1 stated R1 moved two arms while transfer. LPAs interviewed S2. S2 stated R1 needed two caregivers to move/transfer. S2 stated it was tough to take care of R1. S2 stated R1 resisted the care provided by caregivers, sometimes R1 combated with the caregivers when caregivers provided the care or transfer. LPAs interviewed 2 caregivers (S3, S4), and both of them stated R1 resisted care and got excited when caregivers to provide the care and to transfer. Based on the documents reviewed and interviews conducted, there is no evidence shows R1 obtained bruise due to staff's careless. Based on record review of R1's physician report signed and dated 2/20/2019, R1 requires toileting assistance every 3-4 hours. The physician report also states R1 is a fall risk. The Department has investigated the above allegation. Based on interviews, and record review, the department has found the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid, there is not a preponderance of evidence to show the alleged violations did or did not occur. No citations were cited per California Code of Regulations, Title 22. This report was reviewed with ED. A copy of the report was provided to ED.