Health inspection·August 27, 2024

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, facility document review, and facility P&P review, the facility failed to protect the resident's rights to be free from the physical abuse by the facility staff for one of three sampled residents (Resident 1). * Resident 1 was slapped on the face by CNA 1 and sustained a redness to the right cheek. This failure had violated the resident's rights to be free from the abuse and negatively affected the resident's psychological well-being. Findings: Review of the facility's P&P titled Abuse Prevention Program revised on 12/1/22, showed the facility should promote an environment free from any form of resident abuse, neglect, misappropriation of resident property, exploitation and/or mistreatment. Abuse is defined as willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. Abuse also includes the deprivation by an individual, including caretaker, of goods and services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Physical Abuse includes but not limited to hitting, slapping, pinching, and/or kicking. It also includes controlling behavior through corporal punishment. Review of the facility's P&P titled Resident Rights revised 8/2022 showed the resident has the rights to be informed of his or her rights and of all rules and regulations governing resident conduct and responsibilities during his or her stay in the facility. Facility staff shall treat all residents with kindness, respect, and dignity. The section for Policy Interpretation and Implementation showed the Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's rights to a dignified existence; be treated with respect, kindness, and dignity; be free from abuse, neglect, misappropriation of property and exploitation; be free from corporal punishment or involuntary seclusion , and physical or chemical restraints not required to treat the resident's symptoms; self-determination; communicate with and access to people and services, both inside and outside the facility; exercise his or her right as resident of the facility and as a resident or citizen of the United States; be supported by the facility in exercising his or her rights; be informed about his or her rights and responsibilities. Review of the facility's SOC-341 dated 8/21/24, showed Resident 1 reported to the charge nurse that her CNA had slapped her on the right cheek. Further review of the form showed an assessment of Resident 1 was done and Resident 1's right cheek appeared to be slightly red. The incident happened on 8/21/24. (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: 056271 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 056271 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mission Palms Healthcare Center 240 Hospital Circle Westminster, CA 92683 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)