Complaint Investigation Report

Regional Center Representative, Witness 1 (W1) was interviewed and stated they are not aware of visitors being denied visitation at the facility, with the exception of W3. W1 stated W3 has been denied visitation at the request of C1’s family due to concerns of what W3’s intentions with C1 may be and requested W3 not be allowed to spend time with C1. C1’s responsible party, Witness 2 (W2) was also interviewed and stated visitors are allowed at the facility, however, they requested C1 no longer be visited by W3. W2 stated they believe W3’s intentions are sexual in nature and requested facility staff not allow W3 to visit C1. LPA attempted to contact W3 by phone on four occasions to confirm, deny, or provide additional information regarding allegation, however W3 could not be reached.

Interviews were conducted with two facility staff, three facility clients, and three witnesses regarding allegation, facility did not ensure that staff is treating clients with dignity. Two of two staff interviewed stated clients are treated with dignity and denied witnessing or having any knowledge of staff misconduct. Three of three clients interviewed stated they are treated with dignity and denied any concerns regarding inappropriate behavior by any facility staff. During their interview, W1 stated they conducted their own investigation into the allegation, consisting of interviews with clients and staff. Per W1, their investigation did not reveal any wrongdoing by facility staff. During their interview, W2 indicated clients are treated with dignity and denied witnessing or having any knowledge of staff misconduct. LPA attempted to contact W3 by phone on four occasions to confirm, deny, or provide additional information regarding allegation, however W3 could not be reached.

Interviews were conducted with two facility staff, three facility clients, and three witnesses regarding the allegation facility is mismanaging clients' medication. It is alleged facility is administering bedtime medication between 3:30 p.m. – 4:00 p.m. Two of two staff interviewed stated medication is administered following dinner and dinner time is typically between 5:00 p.m. and 6:00 p.m. Per S1, bedtime medication is normally administered at about 7:00 p.m. and clients can go to bed at their own discretion. Three of three clients stated their bedtime medication is administered following dinner, which is typically between 5:00 p.m. and 6:00 p.m., however stated they were unsure of the exact time bedtime medication is administered. During their interview, W1 stated that during their investigation into the allegation, they reviewed Medication Administration Records (MARs) and records were determined to be accurate. W1 stated that per facility staff interviews, medication is given an hour before or an hour after the time stamp on the MAR and for bedtime medication the time stamp is 7 p.m. (Cont. LIC9099-C)