Health inspection·August 15, 2023

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure Certified Nursing Assistants (CNA) 2 and CNA 3 reported allegations of staff to resident abuse for one of two sampled residents (Resident 1), when they witnessed CNA 1 allegedly Roughly placing Resident 1 into a shower chair on 5/23/23, and did not report this to the Abuse Coordinator or anyone else in the facility. This failure had the potential to put all residents at risk for abuse from CNA 1 and prevent the facility from reporting, protecting and investigating abuse allegations. Findings: A review of the facility ' s policy titled, Abuse Prevention Program, revised December 2016, indicated Our residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual or physical abuse, and physical or chemical restraint not required to treat the resident ' s symptoms. This facility ' s policy indicated, Require staff training/orientation programs that include such topics as abuse prevention, identification, and reporting of abuse. Investigate and report any allegations of abuse within timeframes as required by federal requirements; protect residents during abuse investigations. Resident 1 was admitted to the facility on [DATE] for diagnoses that included acute respiratory disease, hearing loss, high blood pressure, and age-related physical disability. On 5/31/23, the facility reported to the California Department of Public Health (CDPH), that CNA 1 had roughly placed Resident 1 in a shower chair back on 5/23/23 around 9:00 am. During an interview on 6/1/23 at 11:00 am, The Director of Staff Development (DSD) confirmed that the facility had not reported the alleged abuse to CDPH immediately, because CNA 2 and CNA 3, had not reported the allegation to anyone in the facility. DSD stated, We did not report this alleged abuse because we did not know about it, [CNA 2] and [CNA 3] did not report this to any staff in the facility which was not in accordance with our Abuse policy and they called the Ombudsman instead. During a phone interview on 6/2/23 at 4:28 pm, the Ombudsman confirmed that she called the facility on 5/31/23 at approximately 9:00 am, and spoke with the Director of Social Services (DSS) about what the facility had done regarding CNA 1 roughly putting Resident 1 into the shower chair. The Ombudsman confirmed that CNA 2 and 3 had informed her of this abuse allegation on 5/23/23 at 1:00 pm. The Ombudsman indicated that she was concerned because she had not received an SOC341 (the official form Page 1 of 2 055807 055807 08/15/2023 Shasta Healthcare 445 Park Street Weed, CA 96094

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few used to report abuse), from the facility, which should have been sent on 5/23/23. The Ombudsman confirmed the DSS did not know anything about this alleged abuse of CNA 1 roughly placing Resident 1 in a shower chair on 5/23/23 at 1:00 pm, this alleged abuse had not been reported to the Abuse Coordinator, a Charge Nurse or anyone from Administration. During an interview on 6/5/23 at 11:45 am, DSS confirmed that the first knowledge the facility had of the alleged abuse, was when she received the call from the Ombudsman who informed her that CNA 2 and CNA 3 had reported the abuse allegation between CNA 1 and Resident 1, which occurred on 5/23/23 at 1:00 pm. DSS confirmed CDPH should have been contacted immediately to report the alleged abuse to Resident 1 and completed an SOC341. DSS confirmed that the facility had not reported the alleged abuse between CNA 1 and Resident 1 to CDPH until 5/31/23, eight days after it should have been reported. 055807 Page 2 of 2