Allegation: Staff verbally abused resident

It is being alleged that R1 was verbally abused by a caregiver at Brittany House. On 6/23/24 LPA Felisa Shirley reviewed an incident report dated 6/13/26 regarding R1 being mishandled. Per interviews on 6/24/26, S5 stated that R1 was having behaviors, screaming and trying to fall to the floor. S5 stated that she called S6 for advice on how to assist R1 as R1 was upsetting other residents. S5 stated that S6 told her that it was okay to let R1 fall out on the floor as it was the best way to assist her. S5 stated that she couldn’t believe that S6 suggested letting R1 fall out on the floor. S5 stated that this is the verbal abuse that she witnessed. During interview on 6/24/26, S6 stated that she witnessed S5 physically threw R1 on the bed in a violent aggressive way. S6 stated she reported the abuse to the Wellness Director. LPA Shirley interviewed S2 on 6/23/26, per interview, the Long Beach Police Department was called but no one came out to take a report. Per interview with S7, S5 was suspended on 6/14/26 and returned to work on 6/18/26, and S6 was suspended on 6/14/26 and per review of resignation letter dated 6/15/26, S6 submitted a Formal Grievance and Letter of Resignation.

LPA interviewed staff 1 – staff 8 (S1 – S8). Of those interviewed 3 out of 8 denied the allegation, 3 confirmed the allegation and 2 did not know. LPA interviewed resident 2 – resident 6 (R2 – R6). Of those who interviewed 5 out of 5 denied the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff verbally abused resident,” therefore, the allegation is unsubstantiated.

Allegation: Staff did not report the incident to the appropriate agencies

It is being alleged that facility staff failed to report incident information to required agencies such as Licensing and to the local ombudsman office. On 6/23/26, LPA Shirley observed the incident report regarding R1, dated 6/13/26. LPA Shirley also reviewed the fax confirmation sheet dated 6/15/26 for Community Care Licensing (CCL) and also the fax confirmation sheet dated 6/15/26 for the local ombudsman.

Con'd on 9099-C

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not report the incident to the appropriate agencies,” therefore, the allegation is unsubstantiated.

Allegation: Staff are not providing residents authorized representative with written incident reports

It is being alleged that a family member requested that all incident reports and concerns be provided to them in writing and this request has not been fulfilled. The family member stated that they are only notified verbally. Per interview with S2 on 6/23/26, incident reports are confidential and internal only. Per S2, staff are required to notify family and responsible parties verbally only.

LPA interviewed staff 1 – staff 8 (S1 – S8). Of those interviewed 3 out of 8 denied the allegation, 2 staff confirmed the allegation and 3 did not know. LPA interviewed resident 2 – resident 6 (R2 – R6). Of those who interviewed 2 out of 5 denied the allegation and 3 were not sure.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff are not providing resident's authorized representative with written incident reports,” therefore, the allegation is unsubstantiated.

No deficiencies were cited for these allegations.

An exit interview was conducted and a copy of this report was provided to the Executive Director, Esperanza Naaktgeboren.