Health inspection·January 16, 2025

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 one of five sampled residents (Resident 4) was not hit by Resident 5. This deficient practice resulted in Resident 4 being punched in the stomach by Resident 5 and had the potential for Resident 4 to suffer physical or psychosocial harm as a result. This deficient practice had the potential for other residents in the facility to be subjected to suffer physical abuse. Findings: 1. During a review of Resident 4 ' s admission Record (Face Sheet), the Face Sheet indicated Resident 4 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus (DM - a disorder characterized by difficulty in blood sugar control and poor wound healing), dementia (a progressive state of decline in mental abilities), bipolar disorder (sometimes called manic-depressive disorder; mood swings that range from the lows of depression to elevated periods of emotional highs), and schizophrenia (a mental illness that is characterized by disturbances in thought). During a review of Resident 4 ' s Minimum Data Set (MDS - a federally mandated resident assessment tool) dated 12/10/2024, the MDS indicated Resident 4 ' s cognition (ability to think and reason) was severely impaired. The MDS indicated Resident 4 did not exhibit any behavioral issues and required supervision or touching assistance (helper provides verbal cues and/or touching assistance) for all activities of daily living (ADLs – routine tasks/activities such as bathing, dressing and toileting a person performs daily to care for themselves) during the assessment period. During an interview on 1/16/2025 at 11:22 a.m. with Resident 4, Resident 4 stated Resident 5 had punched in him the stomach on 1/16/2025 when he was asleep. Resident 4 stated he was scared by being woken up in his sleep and was unsure why he was attacked. 2. During a review of Resident 5 ' s Face Sheet, the Face Sheet indicated Resident 5 was admitted to the facility on [DATE] with diagnoses including encephalopathy (a broad term for any brain disease that alters brain function or structure), schizophrenia, altered mental status, depression (a mental health condition that involves prolonged low mood and loss of interest in activities), and cognitive communication deficit (difficulty in communicating that stems from an impairment in cognitive functions). During a review of Resident 5 ' s MDS, dated [DATE], the MDS indicated Resident 5 ' s cognition was severely impaired. The MDS indicated Resident 5 was dependent (staff does all the effort) for all (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: 055995 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 055995 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE North Long Beach Post Acute 260 E Market St Long Beach, CA 90805 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)