Complaint Investigation Report

9099C-1.. Allegation: Staff engaged in a verbal altercation with client. The complaint alleges that on 4/5/25, (C1) got into a fist fight with staff (S1) due to (S1) stating (C1) could not go downtown with friends that evening.

(C1) stated to the Department that he wanted to go out to eat with a friend and a new staff told him the Administrator said he cannot leave and he doesn't have the right to leave.

Lead Staff stated she was on vacation and out of the facility on 4/5/25 when the alleged incident occurred. This staff stated that (C1) is conserved and requires "eyes on him" at all times, except for when he attends, church, school or another approved program. This lead staff stated (C1) told her "three different versions when she returned" on April 9, 2025. On April 11, 2025, this staff stated she was off-site and called staff, (S1) and she heard (C1) "sobbing and telling (S1) he was sorry and said he would take his meds", stating (C1) "only refused to take his meds that night for (S1) but takes them for all other staff". This staff stated

(S1) and (C1)"typically" get along but when (C1) was told he could not go out, as there was "no "pm" driver that night to pick up him", he became very upset.

Staff (S1) confirmed she was working on the "pm" shift on Saturday, April 5, 2025 and client (C1), was "in a behavioral all day" before the "pm" shift started and then was "trying to leave with friends around 9:00 pm and return around 1-2:00 am. (S1) confirmed (C1) asked if he could leave with friends and (S1) stated she told (C1) she would contact the Administrator, who said it was not okay for him to leave on this outing. (S1) explained (C1)"started throwing things at first in his room" around 2:00 pm at the start of her shift, wouldn't eat dinner or take medications for the evening, and at 10:00 pm, began throwing things in the kitchen and from the fridge. When (C1) took her purse that was on the counter, she ran to his room to get it and then (C1), began "hitting her" as she tried to grab her purse back. (S1) stated (C1)"punched her and kept punching her, giving her a bloody nose, black eye and hurt her jaw". (C1) was not observed to have any bruising or injuries which was also noted by staff, including a facility nurse.

An outside representative who knows (C1) stated (C1) has routinely had complaints about staff not knowing him well and not treating him like he is a high functioning and independent resident. This representative stated she had to remind (C1) to use his calming strategies while telling the story and the story was a bit confusing, but the gist was that (C1) wanted to go out with a friend and asked staff for medications, but staff told (C1) he could not go out and it escalated from there.