Health inspection·September 6, 2024

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, the facility failed to identify an injury of unknown origin as possible abuse for one resident (Resident 1), and failed to report the allegation of abuse to the California Department of Public Health. Residents Affected - Few As a result, the facility failed to initiate their abuse policy and procedure related to an injury of unknown origin and placed Resident 1 at risk for further abuse. This failure also placed other residents at risk for abuse and delayed the abuse investigation proces. Findings: Resident 1's record was reviewed. The Record of admission indicated Resident 1 was admitted to the facility on [DATE] with diagnoses which included Alzheimer ' s disease (a disease which destroys memory and other important mental functions), vascular dementia with behavioral disturbance (a disorder that causes problems with personality and behavior), and hearing loss. According to Resident 1 ' s MDS (an assessment tool), her BIMS (used to assess cognition) indicated Resident 1 was rarely or never understood. On 8/15/24 at 10:32 A.M., a joint observation and interview was conducted in Resident 1 ' s bedroom. Resident 1 was observed laying on her back in bed. Resident 1 had dark purple discoloration surrounding her right eye. Certified Nursing Assistant (CNA) 1 stated staff thinks Resident 1 had a fall, which created the facial bruise, but nobody witnessed it. CNA 1 stated Resident 1 always wore her hair down and a large hat which covered her face. Resident 1 was wearing a black baseball cap, and her hair was down and there was bruising on her face visible from the doorway. CNA 1 was sitting in a chair at Resident 1 ' s bedside. CNA 1 stated she was assigned to stay with Resident 1 and was doing supervision with assistance . which meant always being with Resident 1. CNA 1 stated she is unsure how Resident 1 sustained the injury. CNA 1 stated .it ' s hard to take care of her . and Resident 1 is hard of hearing. CNA 1 stated Resident 1 had aggressive behaviors. She doesn ' t understand that we are only trying to help .[Resident 1] she walks facing down and won ' t let you touch her (Resident 1) and will push you or punch you . On 8/15/24 at 10:56 A.M., Resident 1 was observed waking up. Resident 1 was awake and stated, done here we are eating. Resident 1 said other words that were unintelligible. On 8/15/24 at 11 A.M., an interview was conducted with Licensed Nurse (LN). LN 1 stated on 8/3/24 around 8:30 A.M., Resident 1 was eating breakfast in the dining room. LN 1 stated CNA 2 noticed the bruise on Resident 1 ' s face, then informed LN 1. LN 1 stated staff was not certain when Resident 1 was injured because it was often difficult to see her face. LN 1 stated Resident 1 always wore her (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 055008 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055008 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edgemoor Hospital 655 Park Center Drive Santee, CA 92071 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)