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32 | R1 also expressed uncertainty as to why the matter was being reported, as the altercation was not recent and the issue had been resolved between them.
R2 confirmed that they struck R1 in the ear and that R1 punched them in the nose during the incident. R2 also stated that they and R1 are now friends and reported no further conflict between them.
Staff reported that following the incident, R2’s medication was adjusted and there have been no additional behavioral incidents involving R2. Staff stated that facility protocol is to notify residents’ case managers and psychiatrists when behavioral concerns become a pattern. Staff 2 (S2) confirmed that R2’s case manager was informed of the incident when it occurred and stated there have been no additional altercations between R1 and R2 since that time.
LPA reviewed facility records, which confirmed incident reports were completed and documented on April 8, 2026, and April 28, 2026. Documentation reviewed indicated that the facility addressed the incident appropriately and that no further physical altercations between the residents have been reported.
Based on interviews conducted, records reviewed, and information obtained during the investigation, there is insufficient evidence to support the allegation that staff failed to prevent a resident from engaging in a physical altercation with another resident. Although an altercation did occur, evidence indicates the facility responded appropriately, addressed the incident, and implemented interventions to prevent recurrence.
Therefore, the allegation that staff did not prevent resident from engaging in a physical altercation with another resident is deemed Unsubstantiated. An unsubstantiated finding means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
An exit interview was conducted with the Assistant Manager. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Assistant Manager and her signature on this report confirms receipt. |