Health inspection·March 5, 2024

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, medical record review, and facility document review, the facility failed to protect the resident's rights to be free from the physical abuse by the staff. * Resident 3 was hit on the right of the head by CNA 1 with an open hand, which was witnessed by another staff. This failure had the potential to cause injury and physical and/or psychosocial harm to the resident. Findings: Review of the facility's P&P titled Abuse Reporting and Prevention revised January 2023 showed the Abuse means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, or mental anguish, or deprivation of an individual, including a caretaker, of goods and services that are necessary to attain or maintain physical, mental, and psychosocial wellbeing. This presumes that instances of abuse of all residents, even those in a coma, cause physical harm, or pain, or mental anguish. Physical Abuse means a willful physical action that is meant to inflict physical harm, pain, or mental anguish. Review of the facility's SOC 341 Report of Suspected Dependent Adult/Elder Abuse dated 2/24/24, the document showed an abuse allegation reported by Housekeeping 1. Housekeeping 1 observed CNA 1 hit Resident 3 in the head. Medical record review for Resident 3 was initiated on 2/29/24. Resident 3 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 3's MDS dated [DATE], showed Resident 3 had moderate cognitive impairment (when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life) and was dependent on staff for feeding, mobility (the ability of a patient to change and control their body position) and their activities of daily living (a term used to refer to an individual's daily self-care activities). Review of Resident 3's Progress Note completed by the physician on 1/27/24, showed Resident 3 was alert and oriented to person, place, and time, able to comprehend questions, able to converse and answer basic questions appropriately, and able to make needs know. On 2/29/24 at1030 hours, an interview with the aid of a Vietnamese speaking interpreter was conducted with Resident 3. Resident 3 stated a female staff member had hit him on the right side of the Page 1 of 2 056145 056145 03/05/2024 Garden Grove Post Acute 12882 Shackelford Lane Garden Grove, CA 92841

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few face with their open hand after receiving a shower the previous week. Resident 3 further stated he felt abused by the staff member. On 2/29/24 at 1100 hours, an interview was conducted with Housekeeping 1. Housekeeping 1 stated on 2/23/24 between 1545 and1600 hours, CNA 1 was observed with Resident 3 who was on a shower gurney (a bed used to transport an immobile person to and from a shower area) at the doorway of the shower room. Housekeeping 1 stated CNA 1's face appeared red and observed CNA 1 wiped something off her face. Housekeeping 1 then observed CNA 1 hit Resident 3 on the right temple (side of head) with an open hand. On 2/29/24 at 1130 hours, an interview was conducted with CNA 1. CNA 1 stated on 2/23/24, as she was leaving the shower room with Resident 3, she had to stop and kneel down to wipe the water accumulated under the gurney. While she was wiping the water, Resident 3 spitted and it accidently went into her ear. On 2/29/24 at 1320 hours, an interview was conducted with Family Member 1. Family Member 1 stated they were told by Resident 3 that on 2/24/24, he was hit on the side of the head by a staff member the previous day. On 3/5/24 at 1350 hours, the Administrator and DON were notified of the above findings. Review of the facility's Updated Suspected Abuse Summary and Conclusion report date 3/7/24, showed the facility substantiated the allegation of abuse for Resident 3. 056145 Page 2 of 2