Health inspection·November 22, 2023

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 treat one of four sampled residents (Resident 1) with respect and dignity when Certified Nurse Assistant (CNA) 1 called Resident 1 fat. This deficient practice had the potential to result in psychological harm. Findings: A review of Resident 1's admission Record, indicated Resident 1 was originally admitted at the facility on 7/1/2020 and was readmitted on [DATE] with the following diagnosis of muscle weakness and unsteadiness on feet. A review of Resident 1's History and Physical (H&P), dated 4/13/2023, indicated Resident 1 had the capacity to understand and make decisions. A review of Resident 1's Minimum Data Set (MDS; a standardized assessment and care screening tool), dated 10/20/2023, indicated resident is moderately cognitively impaired for daily decision making. MDS also indicated resident required set up or clean up assistance (helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity) with eating, personal hygiene, and oral hygiene. Resident 1 also required partial/moderate assistance (helper does less than half the effort, helper lifts, holds or supports trunk or limbs, but provides less than half the effort) with toileting hygiene shower/bathe self and upper body dressing; and required substantial/maximal assistance (helper does more than half the effort, helper lifts or holds trunk or limbs and provides more than half the effort) with lower body dressing and putting on/taking off footwear. A review of Resident 2's admission Record, indicated Resident 2 was admitted at the facility on 6/2/2023 with the following diagnosis of muscle weakness and difficulty in walking. A review of Resident 2's H&P, dated 5/29/2023, indicated resident is awake, alert, and oriented x4 (someone who is alert and oriented to person, place, time, and situation) with no apparent distress and no acute disease (NAD). A review of Resident 2's MDS, dated [DATE], indicated resident is moderately impaired for daily decision making. The MDS also indicated Resident 2 required one-person extensive assistance (resident involved in activity, staff provide weight-bearing support) with transfer, walk in room or corridor, dressing and toilet use. The MDS indicated resident required one-person limited assistance (resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing Page 1 of 2 055548 055548 11/22/2023 Pasadena Park Healthcare and Wellness Center 2585 E. Washington Blvd. Pasadena, CA 91107

F 0550 assistance) with bed mobility and personal hygiene. Level of Harm - Minimal harm or potential for actual harm During an interview with Resident 2 on 11/20/2023 at 11:05 AM, Resident 2 stated, CNA 1 would call Resident 1 fat (unable to recall when). Residents Affected - Few During an interview with Resident 1 on 11/20/23 at 11:44 PM, Resident 1 stated that CNA 1 would be rough while providing care to her and it will hurt her. Resident 1 also stated CNA 1 would say she needs to hurt her because she is fat. Resident 1 stated that she felt sad and that she was not treated with respect and dignity. A review of the facility's policy and procedure titled Resident Rights - Quality of Life, revised 3/2017, indicated facility staff speaks respectfully to residents at all times, including addressing the resident by his or her name of choice. 055548 Page 2 of 2