Health inspection·July 9, 2025

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 interview, medical record review, facility record review, and facility P&P review, the facility failed to protect the resident's rights to be free from the physical abuse by a resident for one of five sampled residents (Resident 1). * Resident 1 was hit on the nose by another resident (Resident 2), which resulted in Resident 1 having a nasal fracture (broken nose). This failure had the potential to negatively impact Resident 1's well-being.Findings:Review of the facility's P&P titled Abuse, Neglect, Exploitation and Misappropriation Prevention Program revised 4/2021 showed the residents have the right to be free from abuse, this includes but not limited to freedom of physical abuse, protect residents from abuse by anyone including other residents. Review of the facility's SOC 341 Report of Suspected Dependent Adult/Elder Abuse dated 6/24/25, showed a report of a resident-to-resident altercation between Residents 1 and 2 by the ADON. Medical record review for Resident 1 was initiated on 7/9/25. Resident 1 was admitted to the facility on [DATE]. Review of Resident 1's MDS assessment dated [DATE], showed Resident 1 had a BIMS score of 14 (cognitively intact). Review of Resident 1's H&P examination dated 4/15/25, showed Resident 1 had the capacity to understand and make decisions. Review of Resident 1's SBAR Communication Form dated 6/24/25, showed at approximately 1300 to 1310 hours Residents 1 and 2 were in the patio socializing when RN 1 heard a commotion from the patio. RN 1 immediately went to the patio and tried to intervene the altercation from happening, but it was too late. Resident 2 had punched Resident 1 on her nose. RN 1 separated both residents. Resident 1 was assessed for pain, and an ice pack was applied to Resident 1's nose. Resident 1's primary physician ordered to transfer Resident 1 to the acute care hospital for further evaluation due to the bleeding of the nose post resident to resident altercation. Review of Resident 1's acute care hospital record showed Resident 1 was admitted to the acute care hospital on 6/24/25, for face and nose pain status post being punched in the face twice in the skilled nursing facility. The CT scan performed on 6/24/25, showed the small left frontal (front of the brain, behind the forehead) and supraorbital (the region of the skull directly above the eye socket) scalp hematoma and acute nasal bone fracture (broken nose).On 7/7/25 at 0912 hours, an interview was conducted with Resident 3 (who had the mental capacity to make decisions based on the H&P examination dated 7/6/25). Resident 3 verified she was in the patio when the altercation between Residents 1 and 2 happened. Resident 3 stated she heard Resident 2 pounding on the table saying he had to be in the facility for 180 days and suddenly got mad. Resident 1 asked Resident 2 to leave and suddenly Resident 2 hit Resident 1 twice on the face, then walked away. Resident 3 further stated Resident 1 was screaming and blood was coming out of her nose. Resident 3 denied hearing Resident 1 cursing at Resident 2.On 7/7/25 at 0939 hours, an interview was conducted with Resident 4 (who had the capacity to understand and make decisions based on the H&P examination dated 1/15/25). Resident 4 verified she was in the patio when the altercation between Residents 1 and 2 happened. Resident 4 stated the residents were sitting in the (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 3 Event ID: 055330 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 055330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehab Center of Tustin 2210 E. First Street Santa Ana, CA 92705 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)