Health inspection·August 17, 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 interview and record review the facility failed to ensure reference checks were completed prior to hiring a certified nurse assistant (CNA). This failure had the potential to increase the possibility of abuse toward residents of the facility. Findings: A report of sexual abuse was received by the California Department of Public Health San Diego District Office on 1/10/22. An unannounced visit to the facility was conducted on 1/11/22. Resident 1 was admitted to the facility on [DATE] with diagnoses that included cognitive communication deficit (difficulty with thinking and using language) and bipolar disorder, severe, with psychotic features (episodes of mood swings with depressive lows to manic highs) according to the facility's admission Record. Resident 1 was transferred to the hospital on 1/7/22 for chest pain, and while in the Emergency Department, indicated an incident of sexual assault by a staff member at the skilled nursing facility. Resident indicated the staff member was a CNA who worked at 6 P.M.; and further indicated the incident occurred on 1/6/22 . A review of the facility's staff assignments indicated CNA 1 was assigned to Resident 1 on 1/6/22. CNA 1 was not available for interview. An interview was conducted on 1/11/22 at 12:45 P.M. with licensed nurse (LN)1. LN 1 stated, I am familiar with Resident 1; Resident 1 never mentioned any abuse, sexual or not to me. An interview was conducted on 1/11/22 at 1:40 P.M. with the Social Services Director (SSD). The SSD stated: Resident 1 never mentioned any abuse here but did talk about previous domestic abuse and never indicated any person who was inappropriate with her. The incident was reported to the General Acute Care Hospital (GACH) Sexual Assault Response Team, the police department and the Department of Justice (DOJ); however, the facility failed to fully (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: 055890 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 055890 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/17/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Magnolia Post Acute Care 635 S Magnolia Ave El Cajon, CA 92020 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)