Complaint Investigation Report

435202705-12-1-2025-26-AS-ACON-DRKNN3-20260223093603

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CENTRAL COAST CR/RES , 2580 N. FIRST STREET, STE. 350

This is an official report of an unannounced visit/investigation of a complaint received in our office on

11/21/2025 and conducted by Evaluator Audrey Jeung

COMPLAINT CONTROL NUMBER: 26-AS-20251121154338

- Staff failed to prevent client from pushing another client

LPA Jeung met with resident care coordinator and acting administrator, interviewed staff, and reviewed client files and staff training records. Copies of relevant documents are provided. An incident occurred on 10/31/25--and Unusual Incident Reports were submitted to CCLD, reporting that client #1 pushed client #2 to the floor, sustaining a closed head injury. Names of staff involved were not included in Report; this information is provided to LPA today.

On that day, there were 4 caregivers on work schedule, plus a med tech and housekeeper. LPA interviewed 3 staff who worked on 10/31/25. Staff were unable to prevent client from harming another resident. When client's adverse behavior was observed, staff reacted appropriately to intervene and try to prevent anyone from harm.

Based on review of facility and other reports and interviews with staff, this allegation is determined to be unsubstantiated. Although the allegation may have occurred or is valid, there is not enough evidence to prove the alleged violation did or did not occur.

Updated Personnel Report (LIC500) is requested to be sent to CCLD BY 12/5/25.