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
observation, interview, medical record review, facility document review, and facility P&P review, the facility
failed to ensure one of nine sampled residents (Resident 1) was free from abuse. * CNA 5 borrowed $500
from Resident 1, which caused Resident 1 to feel worried and emotional when the money was not returned
on time. CNA 5 then asked Resident 1 to lie and say the money was payment for work CNA 5 had done for
the resident. This failure negatively affected Resident 1's emotional wellbeing.Findings: Review of the
facility's P&P titled Abuse, Neglect, Exploitation or Misappropriation Prevention Program revised 4/2021
showed the residents have the right to be free from abuse, neglect, misappropriation of resident property
and exploitation Review of the facility's SOC 341 dated 12/29/25, showed Resident 1 loaned CNA 5 $500,
and the money had not been fully returned. Medical record review for Resident 1 was initiated on 1/29/26.
Resident 1 was admitted to the facility on [DATE] and readmitted to the facility on [DATE]. Review of
Resident 1's H&P examination dated 7/14/25, showed Resident 1 had the capacity to understand and make
medical decisions. The H&P further showed the resident 1 had diagnoses including generalized anxiety
disorder. Review of Resident 1's SBAR Communication Form dated 12/29/25, showed there was a change
in condition regarding the resident lending money to a staff member. Review of Resident 1's care plan
dated 12/29/25, showed the resident was at risk for emotional distress and anxiety related to a recent
incident when the resident voluntarily lent money to CNA 5 out of pity. Review of Resident 1's Progress
Note dated 12/29/25, showed the ADON met with Resident 1 to discuss the matters of a CNA, who
Resident 1 had stated borrowed $500 dollars. Further review of the Progress Note showed Resident 1
informed the ADON CNA 5 had expressed to Resident 1 she had financial struggles which caused
Resident 1 to feel bad, so she loaned CNA 5 $500. Resident 1 further stated to the ADON CNA 5 paid
Resident 1 $250 a week ago, but Resident 1 was worried because she had not received the rest of the
money. Review of Resident 1's MDS assessment dated [DATE], showed the resident was cognitively intact.
On 1/29/26 at 1315 hours, an interview was conducted with Resident 1. Resident 1 stated CNA 5 was one
of the best CNAs she ever had. Resident 1 stated CNA 5 told her about the personal and financial
hardships she was facing, and had offered CNA 5 $500 to help with the financial hardships. Resident 1
stated CNA 5 informed her she would pay her back in two weeks. Resident 1 stated CNA 5 paid her $250 a
week later. Resident 1 stated CNA 5 then blocked her phone and stopped communicating. Resident 1
stated it was getting close to Christmas time and she was getting worried. Resident 1 stated she did not
want to report it but one of the nurse supervisors overheard her talking about it on the phone with her sister.
Resident 1 stated CNA 5 then contacted her and asked her to lie and say she had done work for her.
Resident 1 stated it made her feel emotional. On 2/2/26 at 0949 hours, an interview was conducted with the
SSA. The SSA stated Resident 1 informed them CNA 5 spoke to Resident 1 about CNA 5's struggles
outside of work. The SSA stated Resident 1 felt sad about CNA 5's situation and did not want CNA 5 to get
in trouble, but she just wanted the rest of the money back.
Residents Affected - Few
(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:
056110
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
056110
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/04/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Laguna Hills Health and Rehabilitation Center
24452 Health Center Drive
Laguna Hills, CA 92653
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)
F 0602
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
On 2/2/26 at 1010 hours, an interview, medical record review and concurrent facility document review was
conducted with the ADON. Review of the Employee handbook dated June 2024 showed under the section
of giving and receiving gifts showed, staff cannot solicit or accept tips, gifts, loans, gratuities, bequests, or
any item of value from any resident, family member, or visitor or any other person conducting business with
the facility. Employees were also not allowed to purchase items or borrow money from residents. Any
violation of the facility's gifts and gratuities policy could result in disciplinary action. The ADON stated every
new employee receives a copy of the employee handbook upon hire. The ADON stated it was also included
in the abuse training. On 2/4/26 at 1730 hours, an interview was conducted with the DON and the
Administrator. The Administrator stated CNA 5 should not have taken the money from the resident. Cross
Reference to 684
Event ID:
Facility ID:
056110
If continuation sheet
Page 2 of 3
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
056110
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/04/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Laguna Hills Health and Rehabilitation Center
24452 Health Center Drive
Laguna Hills, CA 92653
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)
F 0684
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and medical record review, the facility failed to conduct the status post change of condition
assessments for one of nine sampled residents (Resident 1). * The facility failed to conduct any follow up
nursing assessments on Resident 1 who had a change of condition involving an incident where a CNA
borrowed money from Resident 1. This failure posed the risk for changes in Resident 1's psychosocial
well-being not identified and potentially delayed the necessary care and treatment for the resident.Findings:
Medical record review for Resident 1 was initiated on 1/29/26. Resident 1 was admitted to the facility on
[DATE] and readmitted on [DATE]. Review of Resident 1's H&P examination dated 7/14/25, showed
Resident 1 had the capacity to understand and make medical decisions. Resident 1 had diagnoses
including generalized anxiety disorder. Review of Resident 1's MDS assessment dated [DATE], showed
Resident 1 was cognitively intact. Review of Resident 1's SBAR Communication Form dated 12/29/25,
showed there was a change in condition regarding Resident 1 lending money to a staff member. Review of
Resident 1's Care Plan Report initiated on 12/29/25, showed a care plan problem to address Resident 1's
risk for emotional distress/anxiety related to recent incident of voluntarily lending money to CNA out of pity.
Review of Resident 1's Progress Notes dated 12/29/25, showed the ADON met with Resident 1 to discuss
the matters of a CNA who Resident 1 had stated borrowed $500 dollars from her. Further review of the
progress notes showed Resident 1 stated to the ADON CNA 5 had expressed to Resident 1 she had
financial struggles which caused Resident 1 to feel bad, so Resident 1 loaned CNA 5 the money. Additional
review of the progress notes showed Resident 1 stated CNA 5 had paid Resident 1 back the $250 a week
ago; however, Resident 1 was worried because she had not received the rest of the money. On 2/2/26 at
1450 hours, a concurrent interview and medical record review was conducted with the ADON. The ADON
stated following a change in condition, nurses are required to conduct nursing assessments related to the
change in condition every shift for 72 hours. The ADON stated the purpose of the post event nursing
assessments was to address any potential complications from the specific change in condition. Review of
Resident 1's progress notes did not show any post event nursing assessments and monitoring related to
the change of condition incident. The ADON verified the nursing assessments were not done. Cross
Reference to F602.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056110
If continuation sheet
Page 3 of 3