Inspection·March 21, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to protect 1 of 3 residents (Resident 1) when Resident 1 sustained an injury of an unknown origin to his left pinky finger. In addition, the certified nursing assistant (CNA) did not check on the Resident at the beginning of her shift. This had the potential to impair Resident 1's quality of life and delay in noticing any changes of Resident 1's condition. On 2/16/24, the facility reported an injury of unknown source to the Department. The report also stated that CNA 1 was suspended pending investigation. On 2/22/24 at 8 AM, an unannounced visit was conducted. A review of Resident 1 ' s admission record indicated he was admitted to the facility on [DATE] with medical diagnoses of cerebral vascular accident (blockage in the brain) right hemiplegia (weakness), dysphagia, (inability to swallow food or liquid), aphasia, (inability to talk). On 2/22/24 at 11 A.M., an observation of Resident 1 was conducted in his room with the presence of Licensed Clinical Social Worker (LCSW) 1. Resident 1 laid on his back with head of bed 45 degrees. Resident 1 was interviewed but he did not respond to any question asked. Review of Resident 1 ' s Minimum Data Set (MDS, a nursing assessment tool) dated 2/5/24 indicated Resident 1 was rarely/never understood. The MDS also indicated Resident 1 was dependent on staff for toileting, turning and repositioning. A review of Resident 1 ' s nursing interdisciplinary notes progress, dated 2/15/24 at 21:51 P.M( 9 p.m.)., indicated, Around 1800 (6 p.m.) CNA was doing her rounds and noticed Resident ' s left pinky has purplish/bluish discoloration with bruising and mild swelling. Assessed patient and asked if resident has pain when hand is touched, and resident nodded. CNA reported that shower was given in the morning. MD (medical doctor) ordered X-ray (photo image of a body) and result showed mildly displaced fracture at the base of the fifth proximal phalanx (pinky finger) . Result forwarded to MD. A review of Resident 1 ' s X-ray result of the left pinky finger dated 2/15/24, indicated, Mildly displaced fracture at the base of the fifth proximal . A review of Resident 1 ' s weekly summary dated 2/15/24 completed by the day shift (7 AM to 3 PM) licensed nurse was conducted. (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: 055074 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 055074 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/21/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Coronado D/P Snf 233 Prospect Place Coronado, CA 92118 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)