Health inspection·June 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. Based on interviews and record reviews the skilled nursing facility did not ensure Residents were free from abuse for one of three sampled residents (Resident 1) when Resident 1 ' s Certified Nursing Assistant stated Resident 1 was Ugly. This resulted in unnecessary emotional distress for Resident 1. Findings: Record review of Resident 1's document admission Record showed the facility admitted Resident 1 on June 2018. Diagnoses included a stroke (a medical condition in which poor blood flow to a part of the brain causes cell death.) Record Review of Resident 1's document MDS 3.0 Nursing Home Quarterly (NQ) dated 3/13/2025, showed Resident 1 had no hallucinations or delusions and no physical or verbal behavioral symptoms directed towards self or others. Record review of Resident 1's document eINTERACT Change in Condition Evaluation – V 5.1 dated 5/17/2025, showed Resident 1 had reported to staff CNA 1 had entered his room the previous night and started Yelling and cussing. During an interview at 9:52 a.m. on 6/3/2025, the facility ' s administrator (ADM) stated Certified Nursing Assistant 1 (CNA 1) had reported Resident 1 told her she was Ugly. CNA 1 stated she told Resident 1 You are ugly too. During an interview at 9:55 a.m. on 6/3/2025 Resident 1 stated CNA 1 Used to curse me out but that he hadn ' t Seen her in a while. Resident 1 stated the situation had Upset him. CNA 1 was not available to be interviewed as she no longer works for at the facility. Record review of the document Abuse Prevention and Management dated 2022 showed The Facility does not condone any form of resident abuse, neglect, misappropriation of resident property, exploitation, and/or mistreatment. The Facility develops policies, procedures, training programs, and screening and prevention systems. Page 1 of 2 056280 056280 06/03/2025 Bay Marina Post Acute 2919 Fruitvale Ave Oakland, CA 94602

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on interviews and record reviews the Facility did not take the necessary steps to prevent abuse for one of three sampled Residents (Resident 1). Certified Nursing Assistant 1 (CNA 1) verbally abused Resident 1 and was not immediately removed from providing direct patient care. Residents Affected - Few This resulted in the potential for further abuse. Findings: Record review of Resident 1's document admission Record showed the Facility admitted Resident 1 on June 2018. Diagnoses included stroke(a medical condition in which poor blood flow to a part of the brain causes cell death.) Review of Resident 1's document MDS 3.0 Nursing Home Quarterly (NQ) dated 3/13/2025, showed Resident 1 had no hallucinations or delusions and no physical or verbal behavioral symptoms directed towards self or others. Record review of Resident 1's document eINTERACT Change in Condition Evaluation - V 5.1 dated 5/17/2025, showed Resident 1 had reported to staff CNA 1 had entered his room the previous night and started Yelling and cussing. During an interview at 9:52 a.m. on 6/3/2025, the facility's administrator (ADM) stated Certified Nursing Assistant 1 (CNA 1) had reported Resident 1 told her she was Ugly. CNA 1 stated she then told Resident 1 You are ugly too. During an interview at 9:55 a.m. on 6/3/2025 Resident 1 stated CNA 1, Used to curse me out but that he hadn't Seen her in a while. Resident 1 stated the situation had Upset him. During an interview at 10:16 a.m. on 6/3/2025, the Facility's Payroll Manager (PM) stated CNA's official separation date from the facility was 6/2/2025. During an interview at 10:55 a.m. on 6/3/2025, the PM stated CNA 1 continued to provide Resident care following the incident . In a concurrent record review of the document Time Card Report dated 5/16/2025 to 5/31/2025, showed CNA 1 had Clocked in on 5/18/2025 and clocked out 5/19/2025, the day following the abuse incident. CNA 1 then Clocked in on 5/23/2025 and out on 5/24/2025. Record review of the document Reporting Abuse dated 1/8/2014, showed Upon an allegation of abuse by a Facility Staff member, the Facility Staff member will be suspended and removed from the premises during the investigations. 056280 Page 2 of 2