In September 2019, plaintiff Marie Singleton, a 79 year old who suffered from Lewy body dementia, was a resident of Integrated Care Communities, an assisted living facility in Moreno Valley, when she was diagnosed with an injury to her coccyx. Singleton began living at Integrated Care Communities in 2018, during which time she was cognizant, walking and eating. It was later determined, in September 2019, that she could not walk without pain, would scream whenever her legs were moved, and was incontinent of bowel and bladder. The facility’s staff at that time discovered a large knot on Singleton’s tailbone area with a bad smell, so Singleton was given a shower. However, Singleton was eventually taken to a hospital about six or 12 hours later for treatment of her coccyx injury. Singleton claimed that the injury to her coccyx was a stage IV pressure sore, which is alternately termed a "decubitus ulcer" or "bedsore." Singleton sued the operator of the assisted living facility, Integrated Care Communities Inc.; and the facility’s management group, California Drug Consultants Inc. (which was doing business as Integrated Care Communities-A1). Singleton alleged that the defendants failed to properly diagnose and timely treat her condition and that their failures constituted elder abuse. Integrated Care Communities Inc. and California Drug Consultants Inc. were deemed one and the same for the purpose of trial. Plaintiff’s counsel argued that the facility’s staff failed to treat Singleton’s condition, delayed in treating Singleton or getting Singleton medical treatment, and failed to properly monitor Singleton. Counsel also argued that the staff failed to properly assess Singleton’s condition, failed to note the medical changes that resulted in the discovery of the pressure sore, and failed to immediately report the medical changes to Singleton’s physician. Specifically, plaintiff’s counsel contended that Singleton had a decrease in her appetite, an increase in pain and tiredness, and pain with ambulation and that Singleton, later, had to utilize wheelchair assistance. Counsel argued that those things all should have been noted as changes by the facility’s staff. Plaintiff’s counsel further argued that the facility should have reassessed Singleton after her condition changed, but that it failed to do so. Singleton’s physician testified that she should have been immediately informed about Singleton’s pressure sore when it was discovered and that if that had been done, she would have changed Singleton’s care plan and/or possibly moved Singleton to a skilled nursing home so that Singleton could receive a higher level of care. The plaintiff’s wound management expert testified that the subject wound was "unstageable" at the time it was initially found and that it would have been present for at least three days to a week. Plaintiff’s counsel added that if the facility’s staff was toileting and bathing Singleton, as they alleged, then the staff would not have been able to miss the wound, unless they were not properly caring for Singleton. The plaintiff’s expert in residential care standard of living opined that assisted living facility breached the standard of care and failed to notify Singleton’s physician once Singleton had changes in her medical presentation. The expert also opined that the facility failed to comply with all regulations set by assisted living facilities, in that the facility failed to put in interventions to prevent a pressure sore, failed to change Singleton’s service care plan and failed to call 911 once its staff discovered the wound. Defense counsel argued that the facility’s staff was not negligent for any alleged delays in obtaining medical care for Singleton. Counsel also denied that Singleton’s wound was a pressure sore, and argued that the facility’s staff, instead, discovered an abscess on Singleton’s tailbone that was not caused by pressure. The defense’s expert in residential care standard of living opined that the facility was not at fault, as it was not a medical provider. The expert also opined that Singleton’s changes were part of an ongoing disease process with her dementia and that the changes were not significant enough to advise Singleton’s physician or update Singleton’s care plan. According to plaintiff’s counsel, the defense’s expert in residential care standard of living opined that the facility’s staff was perfect and that they did not do anything wrong. The defense’s geriatrics expert opined that Singleton’s injury was not due to pressure, but was due to Singleton’s dementia, in that Singleton scratched herself and caused the wound. The expert also opined that Singleton’s wound could have potentially been a pilonidal cyst. In response, plaintiff’s counsel argued that there were issues with the defense’s geriatrics expert’s opinion that the wound could have been a pilonidal cyst. Specifically, plaintiff’s counsel argued that a pilonidal cyst typically occurs when there is a break in the skin, which then gets infected, and that a pilonidal cyst usually appears on males who are hairy, between the ages of teens through 40s, all of which did not apply to Singleton., Singleton was taken by ambulance to a hospital, where she was hospitalized after it was determined that the injury to her coccyx had become infected and that Singleton had become septic. Due to the location of the wound, Singleton had a urinary (Foley) catheter inserted at the hospital so that the wound would not be exposed to urine. She then underwent a wound care evaluation, and a vacuum-assisted closure of the wound was attempted, but it was not successful. Singleton then had a surgical consult for a debridement of the wound, and she eventually underwent two debridement surgeries in October 2019. After the surgeries, Singleton’s coccyx injury was diagnosed as having had been a stage IV pressure sore to her coccyx resulting in sepsis with acute organ dysfunction. She claimed that the stage IV injury was classified as being a sore that went down to the bone, muscle and/or surrounding structures. The plaintiff’s wound management expert testified that Singleton’s wound, prior to treatment at the hospital, would have felt as if one was being struck repeatedly by a hot poker. After being hospitalized for a few weeks, Singleton was taken to her daughter’s home, where she will be cared for by her daughter and her grandchildren. Singleton claimed that she will require a Foley catheter for the rest of her life and that with the catheter, she will be more prone to getting urinary tract infections and having bladder spasms. She alleged that as a result, she will continue to need wound care, changing of the catheter and 24-hour care, as she was left bedbound after the events. Singleton sought recovery of damages for her past and future pain and suffering. She also sought recovery of punitive damages against Integrated Care Communities as a result of its alleged conduct.