Inspection·November 7, 2023

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 interview and record review the facility failed to protect one of one resident (Resident 1) from misappropriation of property (deliberate misplacement exploitation, or wrongful, temporary, or permanent use of a resident ' s belongings or money without the resident ' s consent) when Housekeeper 1 (HK 1) was running several personal errands procuring personal items, bringing the items to Resident 1, and cashing personal checks from Resident 1. Residents Affected - Few This deficient practice placed Resident 1 at risk for misappropriation of property. Findings: During a review of Resident 1 ' s admission Record, the admission record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including end stage renal disease (kidney [organ that filters wastes and extra fluid from the body] failure), hemiplegia (paralysis of one side of the body), type 2 diabetes mellitus (a problem in the way the body regulates and uses sugar as a fuel) and heart failure (heart cannot pump as it should). During a review of Resident 1 ' s Minimum Data Set (MDS), an assessment and care screening tool), dated 9/11/2023, the MDS indicated Resident 1's cognition (ability to think, understand, learn, and remember) was moderately impaired. During a review of Resident 1 ' s history and physical (H&P), dated, 7/14/2023, the H&P indicated Resident 1 recognized family, staff, and routines 75 to 90 percent of the time and needed occasional prompting. The H&P indicated Resident 1 was pleasant and slightly confused. During a review of Resident 1 ' s Report of Suspected Dependent Adult/ Elder Abuse (SOC 341), completed 11/1/2023, the SOC 341 indicated family member 1 (FM 1) alleged an employee was involved in questionable bank transactions with Resident 1. During a review of the facility ' s Investigation Summary for Resident 1 ' s abuse allegations, dated 11/6/2023, the summary indicated HK 1 confirmed that HK 1 made purchases for Resident 1. During an interview with the Social services director (SSD) on 11/20/2023 at 12:02 p.m. HK 1 should not have run any errands for Resident 1. SSD stated HK 1 should have notified the activity director in charge of running errands to pick up personal items. The SSD stated when we handle finances everything is logged, and we give them a receipt for transactions. During an interview with HK 1 on 11/20/2023 at 12:20 p.m., HK 1 stated Resident 1 was HK 1 ' s best (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: 056164 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 056164 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/07/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pacific Palms Healthcare 1020 Termino Avenue Long Beach, CA 90804 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)