Complaint Investigation Report, 08/22/2024 — Mission Bay, INC., San Jose CA

On July 26 and August 13, 2024, LPA Monter interviewed staff S1-S6. Staff S1, S2 and S3 stated on July 2, 2024, C1 was having an behavior inside the van, in the parking lot of the Milpitas library. S1, S2 and S3 stated C1 was having behavior like throwing shoes and grabbing him/herself. S1 stated he did see the red mark on C1’s arm and believed it came from the tantrum.

6 Out of 6 staff interviewed stated they did not see Client C1 hit/bite him/herself. 6 Out of 6 staff interviewed stated they did not see other clients hit/bite C1. 4 Out of 6 staff interviewed stated C1 does hit him/herself when upset/ during a tantrum.

Based on record review, Client C1 attends a different Mission Bay Adult day program in the morning. (220 South Main St. Client). C1 attends Mission Bay (980 Rincon Circle) in the afternoon.

On August 22, 2024 LPA Monter conducted a collateral visit at Mission Bay (220 South Main St.) Based on record review, client C1 is group in with clients C7 and C8. LPA attempted to interview C7 but C7 did not respond to LPA’s questions, and was unable to provide answer due to developmental disability. Client C8 is on vacation and could not be interviewed.

LPA interviewed 5 staff, S7-S11. 5 Out of 5 staff interviewed stated they have not observed C1 bite him/herself. 5 Out of 5 staff interviewed stated they did not observe any clients hit or bite C1. 4 Out of 5 staff interviewed stated C1 has a self injurious behavior wherein C1 will hit him/herself.

Based on a review of C1’s Individual Program Plan (IPP) dated March 29, 2024, C1 has episodes of hitting, pushing, throwing shoes and grabbing others.

Based on a review of Facility Special Incident Report, dated July 9, 2024 states on July 2, 2024 C1 displayed unexpected aggressive behavior. C1 threw his/her shoes at a staff member and attempted to grab staff. C1 also grabbed his/her own arms, causing red marks on his/her left arm. The incident report states an ice pack was applied to the affected area, which helped the redness subside.