Health inspection·April 30, 2025

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 observations, interviews, and record reviews, the facility failed to follow their policies and procedures for investigating missing items to protect the personal property for one reviewed resident (Resident 1) during a complaint investigation. Residents Affected - Few This deficient practice placed all 91 residents at risk for loss of personal belongings and potential exploitation (taking advantage of a resident for personal gain), especially those with impaired cognition (memory or thinking). Findings: A review of Resident 1's admission Record indicated, Resident 1 was admitted to the facility on [DATE] with diagnoses which included a history of cognitive communication deficit (CCD-understanding what others say and organizing thoughts) and right ear hearing loss. A record review of Resident 1s minimum data set (MDS - a federally mandated resident assessment tool) dated 4/14/25 indicated, a Brief Interview for Mental Status (BIMS- developed by reviewing the resident's status during the prior seven-day period) score of six points out of 15 possible points which indicated Resident 1 had severe cognitive (pertaining to memory, judgement and reasoning ability) deficits. On 4/30/25 12 P.M., an interview was conducted with the Quality Assurance (QA) Nurse. The QA nurse stated on 4/4/25 a Facility Reported Incident (FRI) was previously reported due to Resident 1's allegation of missing money. The QA nurse stated Resident 1 was unsure if she had the missing money with her. The QA nurse stated they investigated the missing money which concluded Resident 1 did not have the missing money with her when she came to the facility per Resident 1 ' s personal belongings list. On 4/30/25 at 12:13 P.M., An interview and record review was conducted with the Social Services Director (SSD). The SSD stated she was informed on 4/17/25 by the nursing staff of the missing gray bag. The SSD stated the nursing staff was not able to place Resident 1 ' s hearing aids in her ear which alerted them [nursing staff] that Resident 1 ' s gray bag was missing because the hearing aids was stored inside Resident 1 ' s gray bag. The SSD stated she spoke with Resident 1 who told her that she had given her gray bag to her personal caregiver (not employed at facility). The SSD stated Resident 1 had told her the contents of the bag which included Resident 1 ' s house keys, phone charger, and hearing aids. The SSD stated Resident 1 ' s personal caregiver had access to her apartment because she had Resident 1's house keys. The SSD stated that she had only met Resident 1 ' s personal caregiver twice because she would come to the facility after hours to visit Resident 1. The SSD stated (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 3 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 04/30/2025 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)