Health inspection·December 13, 2023

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to report an allegation of abuse, in accordance with facility policy and procedure and with state law, for one resident (Resident 1), when the facility did not notify the appropriate agencies such as California Department of Public Health (CDPH), Local law enforcement, and Ombudsman of a potential allegation of abuse, within the required timeframe. This failure had the potential for the alleged abuse to continue and did not allow the appropriate agencies to investigate the allegations. Findings: A review of Resident 1's face sheet (admission record) indicated Resident 1 was a [AGE] year-old female admitted to the facility on [DATE], with a medical diagnosis that included: Chronic obstructive pulmonary disease (COPD, a lung disease that makes it hard to breathe), metabolic encephalopathy (an alteration in consciousness due to brain dysfunction), Wernicke's encephalopathy (a degenerative brain disorder caused by the lack of vitamin B1), Spondylolysis, Lumbar region (a stress fracture through the pars interarticularis of the lumbar vertebrae), and Pleural Effusion (A buildup of fluid between the tissues that line the lungs and the chest) . Resident 1 had a Brief Interview for Mental Status (BIMS) score of 13, (BIMS score ranges 0 to 7 suggests severe cognitive impairment, 8 to 12 points suggests moderate cognitive impairment and 13 to 15 points suggests cognition is intact). During a telephone interview on 10/11/23 at 9:20 a.m., the Ombudsman stated she had been working with Resident 1 and the facility since hearing about complaints, starting in July, prior to the current abuse allegation reported on 10/6/23. During an interview on 10/11/23 at 10:30 a.m., the Administrator was asked about the abuse allegations for Resident 1 and when they occurred. The Administrator stated the current allegations of, rough handling, were reported and investigated on 10/4/23, when Resident 1 reported five incidences of rough handling by staff. During an interview on 10/11/23 at 11:15 a.m., Resident 1 stated the care was sometimes good and sometimes not good. Resident 1 stated she did not feel safe, and the CNAs smacked her foot into the closet. When asked, Resident 1 did not specify when the incident occurred. During a telephone interview on 12/5/23 at 2 p.m., the Administrator was asked for the time frame when the allegations of rough handling started and the policy and procedure for abuse reporting. An email was received on 12/6/23, indicating an incident involving three Certified Nursing Assistants (CNAs) was brought to an Interdisciplinary Team Meeting (IDT) on 08/08/23, and was reviewed. Education Page 1 of 2 055003 055003 12/13/2023 Eureka Rehabilitation & Wellness Center, LP 2353 Twenty Third St Eureka, CA 95501

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was provided to the staff, but the incident was not presented as an abuse allegation (no documentation was provided for the IDT meeting on 8/8/23). The facility policy and procedure titled, Abuse-Prevention, Screening, & Training Program, revised July 2018, indicated, Abuse is defined as the willful, deliberate infliction of injury .mistreatment, and injuries of unknown source or punishment with resulting physical harm, pain, or mental anguish. Injury of unknown source, is defined as an injury that meets both of the following conditions: 1. The source of the injury was not observed by any person . and; 2. The injury is suspicious because of the extent of the injury, the location of the injury . Requirement to Report Suspected Abuse of Dependent Adult/ Elders, form indicated, Reporting Responsibilities and Time Frames: Any mandated reporter . within the scope of his or her employment, has observed or has knowledge of an incident that reasonably appears to be abuse or neglect, is told by an elder or dependent adult that he or she has experienced behavior constituting abuse or neglect . shall complete SOC 341 . for each report of known or suspected instance of abuse . Reporting shall be completed as follows: .report by telephone to the local law enforcement agency immediately and no later than two (2) hours after observing, obtaining knowledge of, or suspecting physical abuse. 055003 Page 2 of 2