Inspection·July 11, 2023

F 0602 Protect each resident from the wrongful use of the resident's belongings or money. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and review, the facility failed to ensure one of three sampled residents (Resident 1) was protected from misappropriation of the resident's property. Residents Affected - Few This had the potential for fraud and exploitation against Resident 1 and other vulnerable residents. Findings: Review of Resident 1's clinical record indicated, she was an [AGE] year-old with a history including Parkinson's disease (a disease that include symptoms of slowness of movements, muscle rigidity, involuntary tremors/shaking and impaired balance and posture) and dementia (decline in mental capacity affecting daily function). Further review of Resident 1's clinical record indicated, her brief interview for mental status (BIMS, cognition level) of 11 which indicated moderate cognitive impairment and had a responsible party (RP, a person empowered to make decisions for the resident/ person legally responsible and liable for a decision or an action) in place. During an interview with the Social Services Director (SSD), on 7/11/23 at 11:55 a.m., the SSD indicated Resident 1 came to her .confused and upset regarding purchases made on her debit card and indicated Resident 1 stated it was around $400 over several months. The SSD indicated Resident 1 did not recall making or authorizing the purchases. During a record review, on 11/10/22, Resident 1's notes indicated an interdisciplinary team(a group of health care professionals from diverse fields who work toward a common goal for residents) meeting was held to discuss Resident 1's concern over bank transactions indicating online purchases of food and drink ordered and delivered to the facility. The note indicated the purchases were for coffee and food for staff, peers, and Resident 1. The note further indicated the Activities Director (AD) assisted the resident to complete the purchases. During a record review of the facility's undated investigation, the investigation indicated Resident 1 did not recall giving the AD authorization for any purchases with her debit card. The investigation notes further concluded the AD was suspended and given a disciplinary written reprimand on the violation of policy after the AD acknowledged accepting treats/gifts from Resident 1. During an interview with Resident 1, on 7/11/23 at 11:45 a.m., Resident 1 did not recall the incident or any incident involving her debit card being used to make purchases for herself, staff, and (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: 055871 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 055871 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor Skyline Care Center 348 Iris Drive Salinas, CA 93906 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)