Complaint Investigation Report

Allegation: Client sustained multiple unexplained injuries while in care

The allegation alleges that a Client was observed with multiple bruises on their legs.

During the facility visit, LPA observed Client C1 assist staff with bringing laundry downstairs. LPA observed C1 walking toes and lose balance as they walked by a cabinet and bumped into it.

During record review, LPA received and reviewed an incident report for C1 dated 04/20/2024, stating that on 04/18/2024, the Administrator received a call from the regional center informing them the school reported bruising on C1’s legs. Staff stated, in the report, that they did not observe bruising in the morning before C1 left for school. The incident report indicated a video call was conducted with the regional center and one bruise was observed on the back of C1’s thigh. Additionally, LPA received and reviewed C1’s Inland Regional Center (IRC) Person/Family Centered Planning Individual Program Plan (IPP) Summary Sheet dated 04/08/2024, that states on page 5 under Personal and Emotional Growth that C1 “will sometimes have bruising from repeatedly waking into things, but it is not intentional.”

During interviews conducted on 04/26/25 between 9AM and 12PM, with Staff S1-S4, were asked how often body checks are conducted on clients, four (4) out of four (4) stated body checks are conducted daily and if anything is observed it is documented on the form. Additionally, during interviews with, S1-S3 stated C1 has a history of walking on their toes and frequently loses their balance and bumps into things.

During interviews with Client C2, was asked if staff have hurt them, C2 stated staff