Health inspection·November 13, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to report immediately and not later than two hours after receiving an allegation of physical abuse (any intentional act causing injury or trauma to another person by way of bodily contact) by one of fifteen sampled residents (Resident 4) to officials, including the State Survey Agency and law enforcement. This deficient practice resulted in the inability of The California Department of Public Health (CDPH) to investigate the allegations of abuse in a timely manner and placed Resident 4 at risk for continued physical abuse. Findings: During a review of Resident 4's admission Record, the admission Record indicated Resident 4 was admitted to the facility on [DATE] with diagnoses of essential hypertension (high blood pressure) and type 2 diabetes (happens when the body cannot use insulin correctly and sugar builds up in the blood). During a review of Resident 4's Minimum Data Set (MDS, a resident assessment tool) dated 10/9/2025, the MDS indicated Resident 4 had moderate cognitive impairment (a significant decline in thinking and memory that impairs daily functioning, making it difficult to perform complex tasks like managing finances or navigating new places). During a concurrent observation and interview on 11/12/2025 at 9:37 a.m., Resident 4 reported to Licensed Vocational Nurse (LVN) 2 that 2–3 days prior (exact date unknown), she was in the hallway when an unknown individual pulled her hair from behind. LVN 2 was observed present during the disclosure. During an interview on 11/13/2025 at 8:47 a.m., with Resident 4, Resident 4 stated she could not recall the exact date of the incident but remembered being in her wheelchair in the hallway when an unknown individual came up behind her and pulled her hair. Resident 4 reported that no one was nearby to witness the incident, and she was unable to turn around to see who was responsible. Resident 4 stated that she felt the hair pulling, screamed, but no one was present to assist her at that time. During an interview on 11/13/2025 at 9:20 a.m., with LVN 2, LVN 2 stated on the previous day (11/12/2025), Resident 4 informed him that someone had pulled her hair a few days earlier, though she was unable to identify the individual responsible. LVN 2 stated that some residents in Resident 4's unit were known to be unfriendly and that there had been prior incidents of resident-to-resident altercations (dates unknown). LVN 2 stated that it was possible another resident may have pulled Resident 4's hair. LVN 2 stated hair pulling was considered a form of physical abuse. LVN 2 stated that when a resident reports an allegation of abuse, he was required to follow the facility's chain of command, which includes reporting the allegation to the Registered Nurse (RN) supervisor, or, if (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: 056043 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 056043 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Care Center 1913 E 5th Street Long Beach, CA 90802 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)