Health inspection·April 3, 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 observation, interview, and record review, the facility failed to ensure Resident 1 was free from physical abuse when: 1) Resident 1 was hit by another resident and sustained a bloody right lower lip, 2) Resident 1 was touched on the face by another resident (Resident 2) while in Activity room. This failure resulted to Resident 1 being the recipient of physical abuse which affected Resident 1's physical and psychosocial well-being. Findings: A review of Resident 1's Face Sheet, printed 3/3/25, indicated Resident 1's diagnoses of Alzheimer's (a disease characterized by a progressive decline in mental abilities) disease and dementia (a progressive state of decline in mental abilities). 1. During an interview on 2/27/25, at 11:00 a.m., with Licensed Vocational Nurse (LVN) 1, LVN 1 stated on 2/13/25 at 4:15 a.m., LVN 1 was notified by Licensed Vocational Nurse (LVN) 2 that Resident 1 was found in the hallway in her wheelchair with blood coming down from Resident 1's cheek. During an interview on 3/3/25, at 10:55 a.m., with Nursing Supervisor (NS), NS stated Resident 1 got hit on the lower lip. When NS saw Resident 1 that morning, there was dried blood on Resident 1's mouth area. Per NS, Resident 1's skin on mouth area had swelling and bruising. NS added the facility's surveillance video showed Resident 1 going into room [ROOM NUMBER] and showed someone's hand pushing wheelchair out of the room. Per NS, Resident 1 was confused, hard to keep safe, and was wandering. NS stated Resident 1 should have been closely monitored. During an interview on 3/3/25, at 3:23 p.m., with Certified Nursing Assistant (CNA) 1, CNA 1 stated she first saw Resident 1 in the hallway near rooms [ROOM NUMBERS]. Per CNA 1, Resident 1 said a man hit me. During an interview on 3/3/25, at 3:40 p.m., with Administrator (ADM), ADM stated Resident 1 went inside room [ROOM NUMBER]. ADM added video surveillance then showed a hand pushed Resident 1's wheelchair out of the room. During a record review on 4/3/25, at 11:00 a.m., facility document Change of Condition dated 2/13/25 at 10:10 a.m. written by LVN 1 was reviewed. Per Change of Condition, Resident 1 was observed Page 1 of 2 056103 056103 04/03/2025 West Shore Post Acute 508 Westline Drive Alameda, CA 94501

F 0600 bleeding in the mouth. Resident 1 said someone hit her mouth, it was a man. Level of Harm - Minimal harm or potential for actual harm 2. During an interview on 3/3/25, at 1:26 p.m., with Activity Assistant (AA) 1, AA 1 stated Resident 1 was seated at a table by herself in Activity room. Resident 2, in his wheelchair, wheeled self towards Resident 1 and touched Resident 1's left cheek. Per AA 1, Resident 1 asked why Resident 2 was touching her face. Residents Affected - Few During an interview on 4/3/25, at 9:50 a.m., with Director of Nursing (DON), the DON stated Resident 2 made contact with the face of Resident 1 in Activity room. During a record review on 4/3/25, at 11:00 a.m. facility document Discharge Summary dated 2/26/25 by Medical Doctor (MD) was reviewed. Per Discharge Summary, MD noted Resident 1's SNF (skilled nursing facility) stay was complicated by . physical assault by another SNF resident with bruising at her lower lip and right lower chin. During a review of the facility's policy and procedure (P&P) titled, Resident Rights, undated, the P&P indicated, Protection from Abuse: Facilities must protect residents from physical, emotional, or sexual abuse, as well as any form of mistreatment or exploitation. During a review of the facility's policy and procedure (P&P) titled, Abuse Prevention Program, dated August 2017, the P&P indicated, The resident has the right to be free from verbal, sexual, physical, and mental abuse . Residents will be cared for in a safe environment. Resident-to-Resident Abuse . Facility staff will monitor and re-direct residents to ensure the safety of residents and persons within the facility. 056103 Page 2 of 2