Health inspection·January 21, 2025

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 Interview and Record Review the facility failed to report a crime or abuse incident for 1 of 3 residents (Resident 1) when Resident 2 ' s Family Member (FM) exposed himself to Resident 1 while in Resident 1 and Resident 2 ' s shared room. This failure to report to proper authorities placed all residents at risk for allegations of abuse to go unreported. Findings: During a review of the facility ' s policy and procedure titled, Abuse Investigation and Reporting, revised December 2018, the Abuse Investigation and Reporting policy indicated, All reports of resident abuse .(and) mistreatment .shall be promptly reported to local state and federal agencies . A review of Resident 1 ' s medical record indicated Resident 1 was admitted on [DATE] with diagnoses that included, Right Femur Fracture, R Femur Surgical Intervention, and History of Falls. The Minimum Data Set (MDS, Tool for evaluating and implementing a standardized assessment) Brief Interview for Mental Status (BIMS, Section C assessing cognitive function) score dated 1/8/25, indicated Resident 1 rated 15/15, which equates to being cognitively intact. Resident 1 is their own representative (RP) and make their own medical decisions. During an interview on 1/21/25 at 08:30 am, with Resident 1 over the phone, Resident 1 stated Resident 2 ' s Family Member (FM) came out of the shared bathroom and stood at the foot of the bed, made sounds of clearing the throat for attention, and exposed his genitals. I did not feel abused, just very uncomfortable. During an interview with Social Services Director (SSD), in SSD office, on 1/21/25 at 11:00 am, SSD indicated, SSD was aware of the incident, and interviewed both Resident 1 and FM. Resident 1 informed SSD there were no feelings of abuse, just felt very uncomfortable and requested a discharge from the facility. The facility did not file a report based on Resident 1 ' s response. During an interview with Administrator (Admin) in Admin ' s office, on 1/21/25 at 2:10 pm, Admin confirmed he is aware of the incident ' s occurrence, and the investigation was complete. Resident 1 did not wish to pursue reporting or feel the incident was abuse, thus, the facility did not file a report. Based on Interview and Record Review the facility failed to report a crime or abuse incident for 1 Page 1 of 2 055092 055092 01/21/2025 Yuba City Post Acute 1220 Plumas St Yuba City, CA 95991

F 0609 Level of Harm - Minimal harm or potential for actual harm of 3 residents (Resident 1) when Resident 2's Family Member (FM) exposed himself to Resident 1 while in Resident 1 and Resident 2's shared room. This failure to report to proper authorities placed all residents at risk for allegations of abuse to go unreported. Residents Affected - Few During a review of the facility's policy and procedure titled, Abuse Investigation and Reporting , revised December 2018, the Abuse Investigation and Reporting policy indicated, All reports of resident abuse .(and) mistreatment .shall be promptly reported to local state and federal agencies . A review of Resident 1's medical record indicated Resident 1 was admitted on [DATE] with diagnoses that included, Right Femur Fracture, R Femur Surgical Intervention, and History of Falls. The Minimum Data Set (MDS, Tool for evaluating and implementing a standardized assessment) Brief Interview for Mental Status (BIMS, Section C assessing cognitive function) score dated 1/8/25, indicated Resident 1 rated 15/15, which equates to being cognitively intact. Resident 1 is their own representative (RP) and make their own medical decisions. During an interview on 1/21/25 at 08:30 am, with Resident 1 over the phone, Resident 1 stated Resident 2's Family Member (FM) came out of the shared bathroom and stood at the foot of the bed, made sounds of clearing the throat for attention, and exposed his genitals. I did not feel abused, just very uncomfortable. During an interview with Social Services Director (SSD), in SSD office, on 1/21/25 at 11:00 am, SSD indicated, SSD was aware of the incident, and interviewed both Resident 1 and FM. Resident 1 informed SSD there were no feelings of abuse, just felt very uncomfortable and requested a discharge from the facility. The facility did not file a report based on Resident 1's response. During an interview with Administrator (Admin) in Admin's office, on 1/21/25 at 2:10 pm, Admin confirmed he is aware of the incident's occurrence, and the investigation was complete. Resident 1 did not wish to pursue reporting or feel the incident was abuse, thus, the facility did not file a report. 055092 Page 2 of 2