Health inspection·April 8, 2025

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one of three resident's (Resident 1) right to be treated with dignity when a Certified Nursing Assistant (CNA 1) removed bra while in Resident 1's room. This facility failure had the potential to result in a loss of dignity for Resident 1. Findings: During a review of Resident 1's admission Record, dated 4/2/2025, the admission Record indicated in part, Resident 1 was admitted to the facility on [DATE] with the following diagnoses: muscle weakness, aphasia (language disorder that results from brain damage), type 2 diabetes mellitus (the body cannot use insulin [a hormone which regulates the amount of glucose in the blood] correctly and sugar builds up in the blood), cerebral infarction (disrupted blood flow to the brain). During a review of Resident 1's Minimum Data Set (MDS), (a standardized assessment tool to evaluate the health and functional abilities of residents) dated 2/28/2025, the MDS indicated, a Brief Interview for Mental Status ([BIMS] a brief screener to detect cognitive impairment) score of 15 (13 - 15 cognitively intact). During an interview on 4/7/2025 at 1:08 p.m. with the administrator (ADMIN), ADMIN verbalized CNA 1 admitted to removing bra and said it was hot and went behind the curtain and stored the bra in Resident 1's closet. ADMIN stated, We just confirmed that she broke company policy. During a telephone interview on 4/15/2025 at 2:26 p.m. with the Director of Nursing (DON), the DON verbalized it's within the facility policy about employee of sharing personal information .What wasn't followed was sharing personal information like a phone number. During a review of final summary, dated 04/02/2025, the final summary indicated, On 03/27/2025, resident (Resident 1's name) sent an email addressed to Administrator (name), describing verbal, emotional, and physical abuse by CNA 1. (Resident 1's name) also wrote has been sexually harrased by (CNA 1's name) .Resident 1 stated an incident occurred when (CNA 1's name) went into (Resident 1's) room and said (CNA 1) felt hot. Resident stated (CNA 1's name) then went behind the curtain in the room so CNA 1 would not be seen as the bra was removed. CNA (CNA 1's name) stated that they are friends .(CNA 1's name) was asked if (she/he) has ever changed (his/her) clothing in front of the resident. (CNA 1's name) stated, I just take off my bra. Not in front of Resident 1 but in front of B bed, Resident 1 was in A bed. (CNA 1's name) explained that the bra was removed behind a curtain and the resident was not able to see . Investigation conclusion at this time, the facility can confirm that (CNA Page 1 of 2 055342 055342 04/08/2025 Thousand Oaks Post Acute, LLC 93 West Avenida DE Los Arboles Thousand Oaks, CA 91360

F 0550 1's name) violated Company Employee Policy . Level of Harm - Minimal harm or potential for actual harm During a review of the facility's Conduct with Integrity (CWI), (undated), the CWI indicated, Section 2. Quality of Care .Every resident and patient is entitled to dignity, respect and privacy .All residents/patients must be treated with dignity, consideration and respect, and in a manner that preserves self-esteem and promotes resident/patient rights .Violation of resident rights is never tolerated .Harassment - Conduct while at work or when on Employer-related business must be professional at all times. There must be no derogatory references made to or about any person, especially relating to gender, religion, race, or any other protected class. Inappropriate behavior includes, but is not limited to, suggestive gestures, uninviting touching, or sexual advances; sexually explicit, vulgar, crude or offensive language, jokes, photographs or other materials. Modes of communicating inappropriate behavior can include, but are not limited to, written and verbal communication, via telephone, computer systems and other types of media .Dating - Any employee who has a dating relationship or engages in consensual sexual contact or relations with a resident/patient will be subject to disciplinary action, which may include termination . Residents Affected - Few During a review of facility's Work Rules, revised March 2024, the Work Rules indicated, Generally, there are three (3) categories of work rules for employees as listed below .Category 1 work rules generally include, but are not limited to the following: a) Employees must maintain acceptable standards of respect and professional conduct towards residents/patients, visitors, co-workers, and vendors. 055342 Page 2 of 2