Health inspection·September 6, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record review, the facility failed to protect one resident's rights (Resident 2) of three sampled residents, to be free from physical abuse when Resident 1 went to Resident 2's room and pushed Resident 2 out of his wheelchair causing Resident 2 to fall. This failure resulted in Resident 1 physically attacking Resident 2, resulting in a fall and a scratch to the left cheek. Findings: A review of an admission Record indicated Resident 1 was admitted to the facility middle 2023 with multiple diagnoses which included psychoactive substance abuse (an impaired capacity to control substance-taking behavior), bipolar disorder (a mental illness that causes extreme mood swings), and anxiety. A review of a Minimum Data Set (MDS, an assessment tool), dated 8/17/23, indicated Resident 1 had no memory problems. A review of an admission Record indicated Resident 2 was admitted to the facility middle 2019 with multiple diagnoses which included psychotic disorder (affects the mind, where there has been some loss of contact with reality), and dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities). A review of an MDS, dated [DATE], indicated Resident 2 had some memory problems. A review of a facility document titled, SBAR [Situation report]: Change of Condition, dated 8/13/23, at 10:30 a.m., indicated, Resident [1] presented to the [NAME] nurse station re: altercation with 208 [sic]. Resident [1] stated to this writer [Licensed Nurse 3] that he was . going to slap the shit out of him [Resident 2] . Resident [1] went outside and came back into 208's [Resident 2] room, where he proceeded to push 20B [Resident 2] out of his wheelchair and scratched him on the left cheek. A review of Resident 1's progress notes dated 8/13/23, at 11:05 a.m., indicated, .[Resident 1] then confirmed he came back inside the facility, went to [Resident 2]'s room (20B) and proceeded to shake/rattle his wheelchair until [Resident 2] fell out of the chair and scratched [Resident 2] on the left side cheek . A review of Resident 2's IDT (Interdisciplinary team) progress notes, dated 8/14/23, at 9:23 a.m., indicated, . Inside his room res. [Resident 2] stated that res. [Resident 1] came in to his rm. [room] while he was sitting on his wheelchair grabbed his left cheek where he sustained scratch mark and Page 1 of 2 055833 055833 09/06/2023 Fulton Gardens Post Acute, LLC 537 E. Fulton Street Stockton, CA 95204

F 0600 when he tried to stand up he [Resident 1] pulled his wheelchair then he fell . Level of Harm - Minimal harm or potential for actual harm An interview on 9/1/23, at 12:55 p.m., with Resident 1 by his room, Resident 1 was alert and oriented to himself, time and place, sitting on his wheelchair, and cooperative. Resident 1 stated, .He [Resident 2] kept aggravating me for two weeks .in the coffee social, [Resident 2] hit me in the leg and back .then he called me names, I felt threatened by him .I snapped .went to his room, pushed him out of his wheelchair and he fell . Residents Affected - Few An interview on 9/2/23, at 2:13 p.m., with the ADM (Administrator), when asked if each resident has the right to be free from abuse per facility's policy on Abuse Prevention and Prohibition Program, the ADM stated, Yes my expectation is in line with our policy . A review of a facility policy and procedure titled, Abuse Prevention and Prohibition Program, revised October 2022, indicated, To establish, operationalize, and maintain an Abuse Prevention and Prohibition Program designed to ensure .prevention .of resident abuse .Each resident has the right to be free from . abuse .The Facility is committed to protecting residents from abuse by anyone . 055833 Page 2 of 2