Complaint Investigation Report

On October 19, 2022, LPA Chang interviewed S1. S1 stated S1 works for the facility since March 2022. S1 stated S1 did not received any 1 on 1 care training. S1 stated he/she has the experience in working at level 4i facilities before.

On September 14, 2024, LPA Monter interviewed residents R2-R6. 3 Out of 5 residents (R3, R5, R6) stated they didn’t know if staff S1 knew how to redirect resident R1. 2 Out of 5 residents (R2, R4) interviewed were unable to provide answers to LPA's questions. Residents interviewed had behaviors such as not talking, ignoring questions, being distracted and engaging in other actions such as playing with toy/tablet.

On September 10, 14 and 22, 2024, LPA Monter interviewed staff S2-S5. Staff S2 stated he/she was not there at the time and doesn’t know if staff S1 could redirect R1. Staff S3, S4 and S5 stated staff S1 knew how to redirect R1.

Based on a review of R1’s Individual Program Plan (IPP). Dated June 2, 2022, R1 has a history of being injurious to others, which has an average of 2 occurrences per day. R1 also has a history of property destruction.

LPA requested to review S1’s training. ADM stated she did not have any more documents of training. ADM stated she only had training documents from 2023 for S1. ADM stated she tell her staff to train, but they don't like to do it.

Based on interviews and evidenced reviewed the preponderance of evidence standard has been met therefore the above allegations is found to be SUBSTANTIATED .

Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 9099-D.

This report was reviewed with staff Sofia Pansalin and a copy of the report was provided. Appeal Rights was provided.