Health inspection·March 6, 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 three sampled residents (Resident 2) was free from verbal abuse when Licensed Vocational Nurse (LVN) 2 cursed at her. This deficient practice resulted in Resident 2 feeling unsafe when LVN 2 was working in the facility. This deficient practice had the potential to cause psychosocial (mental, emotional, and social) harm. Findings: During a review of Resident 2's admission Record (Face Sheet), the Face Sheet indicated Resident 2 was admitted to the facility on [DATE] with a diagnosis of anxiety disorder (a mental health disorder characterized by feelings of worry, anxiety, or fear that are strong enough to interfere with one's daily activities). During a review of Resident 2's Minimum Data Set ([MDS] resident assessment tool) dated 2/5/2025, the MDS indicated Resident 2 was mildly cognitively (ability to think and reason) impaired. During a review of the facility's Investigation Report dated 2/26/2025, the Investigation Report indicated on 2/25/2025 Resident 2 requested to speak to Licensed Vocational Nurse (LVN) 2 regarding her (Resident 2's) medication. The Investigation Report indicated LVN 2 told Resident 2 that she had already given her, her medication. The Investigation Report indicated Resident 2 asked LVN 2 if her doctor had spoken to the psychiatrist regarding her medication. The Investigation Report indicated Resident 2 cursed at LVN 2 who cursed back at Resident 2. During an interview on 3/5/2025 at 12:26 p.m., Resident 2 stated on 2/25/2025, sometime around 8 p.m., LVN 2 came in her room angry because she (Resident 2) requested to speak with her. Resident 2 stated LVN 2 was yelling and stated she was on her break and had already given her, her medication. Resident 2 stated she expressed to LVN 2 that she did not feel right and wanted to the dosage of her medication adjusted. Resident 2 stated LVN 2 reminded her again that she was on her break, so she (Resident 2) told her Family Member (FM) who was on the phone with her, that LVN 2 was a f****ing b**** and LVN 2 responded no you're a f****** b****. Resident 2 stated she was angry and that LVN 2 responded to her that way, when all she wanted was for LVN 2 to contact her physician about her medication. Resident 2 stated LVN 2's response triggered her which was why she cursed at LVN 2. Resident 2 stated she did not feel safe the rest of the shift with LVN 2 as her nurse. During an interview on 3/5/2025 at 1:09 p.m., Resident 4 stated she witnessed LVN 2 curse at (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: 056007 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 056007 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pacific Care Nursing Center 3355 Pacific Place Long Beach, CA 90806 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)