Health inspection·May 2, 2025

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to protect one resident (Resident 1) of three sampled residents from physical abuse by Resident 2, when Resident 2 deliberately placed his hands on Resident 1 ' s chest and pushed him which caused Resident 1 to fall during an argument over a television (TV) channel inside their room. This failure resulted in a skin tear (a wound caused by direct force which separates the skin ' s layers) and an abrasion (a scrape) on Resident 1 ' s left forearm. Findings: A review of Resident 3 ' s Minimum Data Set (MDS- an assessment tool used by facilities to screen and identify memory, orientation, and judgement status of the resident) dated 3/1/25, indicated a Brief Interview for Mental Status (BIMS- a screening tool used to assess a person ' s memory and cognition (ability to think, understand, remember, and problem-solve)) score of 15, which meant his cognition was intact. A review of Resident 2 ' s MDS dated [DATE], indicated his BIMS score was 13, meaning his cognition was moderately (an observable delay) intact. A review of Resident 1 ' s MDS dated [DATE] indicated Resident 1 ' s BIMS score was 10, meaning his cognition was moderately impaired (diminished). During a concurrent observation and interview on 5/2/25 at 10 a.m. Resident 2 was sitting in his room watching TV. Resident 2 stated Resident 1 changed the channel of Resident 2 ' s television using Resident 1 ' s TV remote control. Resident 2 stated he pushed Resident 1 by placing both his hands on Resident 1 ' s chest to push him. Resident 2 stated Resident 1 fell on the floor. Resident 2 stated there were no staff in the room during that time, but Resident 3 was also in the room. During a concurrent observation and interview on 5/2/25 at 11 a.m., with Resident 1 and Resident 3, Resident 1 showed the Surveyor the island dressing (a highly absorbent layer with an adhesive border) located on his left forearm which measured 2 centimeters (cm- a unit of measure) by 2 cm. Resident 1 stated Resident 2 placed both his hands on his chest and pushed him, causing him to fall. Resident 1 pointed to the part of his bed where he hit his left forearm. Resident 3 stated each resident ' s TV remote controlled all three TV sets in the room. The Surveyor observed Resident 3 use his remote to change the channel of his TV which also changed the channel of Resident 2 ' s television. A review of Resident 1 ' s facility document titled Situation Background, Assessment, Recommendation [SBAR] dated 4/28/25 at 3:15 p.m. indicated, Incident started on 4/28/25, at 3:15 p.m.[Resident 2] (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: 055499 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 055499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rocky Point Care Center 625 16th Street Lakeport, CA 95453 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)