Complaint Investigation Report

The Physician's Report reports C1 has a diagnosis of Intermittent Explosive Behaviors which include physical aggression towards self and staff. LPA also reviewed a Quarterly Assessment Report for C1 that was conducted on November 24, 2025. This report addressed the explosive behaviors exhibited by C1 and the goals and objectives for staff to assist C1 when client has behavior episodes. The report stated C1 has the following targets to meet: 1. Emotional Outbursts, 2: Physical Aggression, 3: Self injurious behaviors, 4: transferring behavior and #5: Throwing Objects. LPA also reviewed Staff #1's records. There are no disciplinary actions against S1 and training was current.

On November 25, 2025 LPA conducted a health and safety check for five of five clients in care. LPA interviewed four of five clients who reside in the home and inquired if they were physically abused by staff. Four of five denied this allegation. One client declined to interview. LPA interviewed six of six staff members. Six of six staff members denied the allegation that staff physical abused a client. Staff also stated the client in question did not have any markings or bruises from the incident; which was reported to have occurred on November 17, 2025. LPA interviewed three of three witnesses. Two of the three witnesses confirmed the allegation that Staff physically abused client. One of the three witnesses could not confirm, nor deny the allegation. Administrator (AD) stated staff member returned to work on Friday, November 28, 2025 and is obtaining documentation regarding approval for staff to return to work. LPA spoke with AD regarding behavior mapping for C1 to ensure behaviors are documented.

Based on LPA's record review, observations and interviews, the allegation that Staff physically abused client is Unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violation occurred. An exit interview was conducted with Gladys Framo, House Manager and a copy of this report was provided to the facility.