Health inspection·May 7, 2025

F 0609 Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Level of Harm - Minimal harm or potential for actual harm Based on interviews and record reviews, the facility failed to ensure: Residents Affected - Few 1. An alleged sexual abuse incident on 4/28/25 was reported to the local ombudsman (an advocate for residents of nursing homes, board and care centers, and assisted living facilities), the California Department of Public Health (the state) and local law enforcement within 2 hours after the allegation was made, 2. Staff were knowledgeable of the abuse reporting guidelines: whom to report abuse allegations and the time frame for reporting abuse allegations, and 3. The facility ' s Abuse Policy and Procedure (P&P) titled Reporting Abuse, revised 1/8/2014, reflects the current reporting guidelines. These failures could put all 52 residents of the facility at risk for abuse without timely interventions. Findings: 1. A review of the Report of suspected Dependent Adult/Elder Abuse, received by the state on 4/28/25 at 12:06 p.m., indicated, .on 4/28/25 at 9:00AM [Resident 2] was getting coffee and greeted [Resident 3]. [Resident 3] responded by saying let ' s go while grabbing [Resident 2 ' s] genital area . and [Resident 2] reported it to the facility dietary Supervisor . During an interview on 5/7/25 at 3:48 p.m., the Social Services Director (SSD) stated abuse allegations should be reported to the state, ombudsman and the police immediately within two hours of incident. The SSD stated the alleged sexual abuse reported by Residents 2 qualified for the two-hour reporting guideline. The SSD stated it was important to report abuse allegations immediately, so it does not happen again, for resident safety and to protect residents from further harm. During a concurrent interview and record review on 5/7/25 at 4:39 p.m., with the Director of Staff Development (DSD), the Report of suspected Dependent Adult/Elder Abuse, dated 4/28/25, was reviewed. The DSD verified that this sexual abuse allegation was reported at 9:00 a.m. and the fax confirmation to CDPH indicated it was sent at 12:06 p.m. The DSD verified the initial report did not meet the 2-hour reporting guideline. The DSD stated all abuse allegations should be reported to the ombudsman, the state and the police within 2 hours of the incident. The DSD stated it was important that abuse allegations were reported timely to ensure residents ' safety. Page 1 of 2 055331 055331 05/07/2025 San Rafael Healthcare & Wellness Center, LP 1601 5th Avenue San Rafael, CA 94901

F 0609 Level of Harm - Minimal harm or potential for actual harm 2. During an interview on 5/7/25 at 4:08 p.m., Licensed Nurse (LN) A stated all abuse allegations should be reported to the ombudsman and CDPH. She stated if the abuse allegation resulted to harm, then it should be reported to the police. LN A stated all abuse allegations should be reported immediately within 24 hours of the incident. She stated it was important to report immediately to provide quick intervention and protect residents from further harm. Residents Affected - Few During an interview on 5/7/25 at 4:10 p.m., LN B stated all abuse allegations should be reported to the state and ombudsman. LN B stated if the abuse was egregious, then it should be reported to the police. LN B stated all abuse allegations should be reported immediately within 24 hours. LN B stated reporting abuse allegations timely ensure events were still fresh on the reporters ' mind, ensure residents safety and could stop the abuse from happening again. During an interview on 5/7/25 at 4:13 p.m., Unlicensed Staff C stated all abuse allegations should be reported to the ombudsman and the state as soon as possible within 24 hours of the incident. Unlicensed Staff C stated it was important to report abuse allegations immediately for residents ' safety and to protect residents from further harm. 3. A review of the All Facilities Letter (AFL, information contained may include changes in requirements in healthcare, enforcement, new technologies, scope of practice, or general information that affects the health facility) 21-26, dated 7/26/21, indicated, . Pursuant to Title 42 CFR section 483.12(c)(1) . facilities must report any instance of suspected or alleged abuse neglect, exploitation, and/or mistreatment of elders or dependent adults to their local law enforcement agency, LTC ombudsman, and [the state]. When to Report . for incidents that involve abuse or result in serious bodily injury, facilities must: Call local law enforcement immediately, but no later than two hours after the allegation is made. File a written or electronic report to the LTC ombudsman, local law enforcement, and [the state] within two hours . for any other reasonable suspicion that does not result in abuse or serious bodily injury, facilities must: Call local law enforcement as soon as possible, but no later than 24 hours after the allegation is made. File a written or electronic report to the LTC ombudsman, local law enforcement and DO within 24 hours . A review of the facility ' s P&P titled Reporting Abuse, revised 1/8/2014, indicated, .If the reportable incident results in serious bodily injury, a telephone report shall be made to the local law enforcement agency immediately and no later than 2 hours of the observation, knowledge or suspicion of the physical abuse. In addition, a written report shall be made to the local ombudsman, the California Department of Public Health and the local law enforcement agency within 2 hours of the observation, knowledge or suspicion of the physical abuse .If the reportable incident does not result in serious bodily injury, the Administrator or his/her designee, will make a telephone report to the local law enforcement agency within 24 hours of the observation knowledge or suspicion of the physical abuse. In addition, a written report shall be made to the local ombudsman, the California Dept of Public Health and the local law enforcement agency within 24 hours of the observation, knowledge or suspicion of the physical abuse .If the suspected abuse is allegedly caused by a resident who has been diagnosed with dementia, and a license nurse reasonably determines that there is no serious bodily injury, the administrator, or his/her designee, shall report to the Ombudsman or law enforcement agency telephone report shall be made to the local law enforcement agency by telephone as soon as practically possible and write a written report within 24 hours of the observation, knowledge or suspicion of the abuse . 055331 Page 2 of 2