Senior Care Records.

Complaint Investigation Report

Ali Baba # 1, San Jose05/12/2022Licence 430700017

Date signed05/12/2022 04:42:15 PM
The inspector’s account

S1 stated that R2 then pushed S1, and then S1 grabbed R2 by the shoulders and pushed R2 down onto the ground of the balcony by the medication room. S1 stated to have put his/her knees on R2's back and told R2 to calm down. S1 stated to have put his/her knee on R2's back for around 10 seconds. S1 stated to prefer that the residents have altercations with S1 than with the other staff.

During interview, resident R9 stated to have witnessed the incident while sitting in the court yard next to the medication room. R9 stated to have observed R2 and S1 arguing and yelling at each other at the medication room, and observed S1 approach R2 from the doorway of the medication room and push R2 down onto the ground of the balcony near the medication room. R9 stated R2 landed on his/her back near the trash can that is near the window of the medication room.

Residents R3-R8 stated to have not observed any staff push a resident. Staff S3-S5 stated to have not observed any staff push a resident. Staff S2 stated during interview to have observed R2 push S1, and then S1 pivoted and pushed R2 up against the wall of the medication room. S2 stated that then R2 slipped underneath S1's arms and ran away.

LPA Marrufo interviewed Designated Administrator Renee Sabankaya, who stated to have not observed or heard about any incident involving a staff pushing a resident.

Deficiencies were cited as per California Code of Regulations Title 22. See LIC9099-D for more information.

This report was reviewed with Renee Sabankaya and a copy of the report was provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction