Other·July 2, 2018

F000 INITIAL COMMENTS

F000 PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE The following reflects the findings of the California Department of Public Health during an abbreviated standard survey. FRI / Complaint #: CA00573067 Deficiencies were identified under the Code of Federal Regulations. The investigation was limited to the specific facility reported incident /complaint and does not represent the findings of a full inspection of the facility. Representing the California Department of Public Health: Health Facilities Evaluator Nurse 37568.

F557 SS=D Respect, Dignity/Right to have Prsnl Property CFR(s): 483.10(e)(2)

F557 §483.10(e) Respect and Dignity. The resident has a right to be treated with respect and dignity, including: §483.10(e)(2) The right to retain and use personal possessions, including furnishings, and clothing, as space permits, unless to do so would infringe upon the rights or health and safety of other residents. This REQUIREMENT is not met as evidenced by: The facility failed to ensure a Certified Nursing LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE 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. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 0JTT11 Facility ID: CA080000099 If continuation sheet 1 of 10 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555246 (X3) DATE SURVEY COMPLETED 06/18/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE VISTA VIEW POST ACUTE 304 N Melrose Dr Vista, CA 92083 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE Assistant (CNA 2) treated 1 sampled resident (Resident 1) with respect when he was observed standing at Resident 1's bedside providing care to the resident with his pants down around his ankles. As a result, Resident 1 did not receive care in a dignified manner. Findings: On 2/8/18, the facility reported an allegation of abuse to the Department. The DON was interviewed by telephone on 2/8/18 at 2:45 P.M. According to the DON, on the night shift on 2/7/18, a Certified Nursing Assistant (CNA 1) observed CNA 2, at a resident's bedside, with his pants down around his ankles. Per the same interview, the resident, who had advanced dementia, was on the bed facing away from CNA 2 with the bed raised to waist level. An unannounced visit was made to the facility to investigate the allegation on 2/8/18. Resident 1's record was reviewed on 2/8/18. Resident 1 was admitted to the facility on 1/12/18, per the facility's Face Sheet. According to the physician's Continuing Care notes, dated 1/14/18, Resident 1 had limited decision-making capacity and was admitted for skilled rehabilitation. According to the Minimum Data Set assessment, completed by facility staff on 1/19/18, Resident 1 scored 10 on the Brief Interview for Mental Status, indicating Resident 1 was moderately impaired cognitively. Documentation on the Monthly Flow Report FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 0JTT11 Facility ID: CA080000099 If continuation sheet 2 of 10 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555246 (X3) DATE SURVEY COMPLETED 06/18/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE VISTA VIEW POST ACUTE 304 N Melrose Dr Vista, CA 92083 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE reflected Resident 1 required extensive staff assistance with personal hygiene and toileting. On 3/1/18 at 1:35 P.M., an interview was conducted with CNA 1. CNA 1 stated on 2/7/18 at approximately 3:45 A.M., she went to Resident 1's room to deliver a letter to CNA 2. CNA 1 stated she was in the hallway outside of Resident 1's room when she overheard Resident 1 state she was cold and asked for her blanket to be put back on. CNA 1 stated when she entered the resident's room, she observed Resident 1 in the bed next to the window. CNA 1 noticed Resident 1's curtain was pulled to the end of the resident's bed, obscuring the view of the resident from the doorway. CNA 1 said she could see below the curtain and CNA 2's pants were around his ankles while he stood facing Resident 1's bed. CNA 1 stated she walked around the curtain to CNA 2 to deliver the letter. CNA 1 stated Resident 1's bed was raised to the same level as CNA 2's waist as he stood there with his pants around his ankles. CNA 1 stated Resident 1 was awake, naked from the waist down and on her left side facing away from CNA 2. CNA 1 stated CNA 2 noticed CNA 1 was in Resident 1's room and grabbed the letter from her hand and read the letter with his pants still around his ankles. CNA 1 stated she was shocked CNA 2 had his pants down and left the room right away. On 3/1/18 at 2:20 P.M., an interview was conducted with CNA 2. CNA 2 stated on 2/7/18 his pants fell down while he was at Resident 1's bedside providing personal care to the resident. CNA 2 stated, CNA 1 walked into Resident 1's room when his pants were down. CNA 2 stated he pulled up his pants after CNA 1 left the room. CNA 2 stated he did not think it was a big deal that his pants fell down in Resident 1's room. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 0JTT11 Facility ID: CA080000099 If continuation sheet 3 of 10 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555246 (X3) DATE SURVEY COMPLETED 06/18/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE VISTA VIEW POST ACUTE 304 N Melrose Dr Vista, CA 92083 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE Resident 1 was discharged from the facility at the time of the investigation and was not available for interview. According to the facility's policy entitled, Dignity, last revised on 6/17/2008, "All residents are treated in a manner and in an environment that maintains and enhances each resident's dignity and respect in full recognition of his or her individuality". Per the same policy, "Through example, education and monitoring, the Social Services staff promote the following types of staff interactions with residents to maintain their dignity ... Assisting residents in daily care in a dignified manner ..."

F607 SS=D Develop/Implement Abuse/Neglect Policies CFR(s): 483.12(b)(1)-(3)

F607 §483.12(b) The facility must develop and implement written policies and procedures that: §483.12(b)(1) Prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property, §483.12(b)(2) Establish policies and procedures to investigate any such allegations, and §483.12(b)(3) Include training as required at paragraph §483.95, This REQUIREMENT is not met as evidenced by: The facility failed to ensure a Certified Nursing Assistant (CNA 1), reported an observation of possible staff to resident abuse by CNA 2, immediately to the facility's abuse coordinator, FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 0JTT11 Facility ID: CA080000099 If continuation sheet 4 of 10 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555246 (X3) DATE SURVEY COMPLETED 06/18/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE VISTA VIEW POST ACUTE 304 N Melrose Dr Vista, CA 92083 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE as required per facility policy. As a result, other residents were placed at risk while CNA 2 continued to provide care for the rest of the shift. Findings: On 2/8/18 at 1:27 P.M., the Director of Nursing (DON) reported to the Department an allegation of staff to resident abuse. The DON was interviewed by telephone on 2/8/18 at 2:45 P.M. According to the DON, on the night shift on 2/7/18, a Certified Nursing Assistant (CNA 1) observed CNA 2, at a resident's bedside, with his pants down around his ankles. The DON also stated although the incident occurred at 4 A.M. in the morning of 2/7/18, she was not informed until 2/8/18. On 2/8/18 at 4:30 P.M., the Department made an unannounced visit to investigate the reported alleged abuse. On 3/1/18 at 1:35 P.M., an interview was conducted with CNA 1. CNA 1 stated on 2/7/18 at approximately 3:45 A.M she went to Resident 1's room to deliver a letter to CNA 2. CNA 1 stated she was in the hallway outside of Resident 1's room when she overheard Resident 1 state she was cold and asked for her blanket to be put back on. CNA 1 stated when she entered the resident's room, she observed Resident 1 in the bed next to the window. CNA 1 noticed Resident 1's curtain was pulled to the end of the resident's bed, obscuring the view of the resident from the doorway. CNA 1 said she could see below the curtain CNA 2's pants were around his ankles while he stood facing Resident 1's bed. CNA 1 stated she walked around the curtain to CNA 2 to deliver the letter. CNA 1 stated Resident 1's FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 0JTT11 Facility ID: CA080000099 If continuation sheet 5 of 10 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555246 (X3) DATE SURVEY COMPLETED 06/18/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE VISTA VIEW POST ACUTE 304 N Melrose Dr Vista, CA 92083 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE bed was raised to the same level as CNA 2's waist as he stood there with his pants around his ankles. CNA 1 stated Resident 1 was awake, naked from the waist down and on her left side facing away from CNA 2. CNA 1 stated CNA 2 grabbed the letter from her hand and read the letter with his pants still around his ankles. CNA 1 stated she was shocked CNA 2 had his pants down and she left the room right away. CNA 1 stated she did not report what she had seen to her supervisor on 2/7/18. CNA 1 also stated CNA 2 continued to work with his residents for the remainder of the night shift. CNA 1 said she had received abuse training from the facility and knew she should have reported the allegation of abuse immediately. CNA 1 said she did not report CNA 2 because, "I was so shocked, I forgot what to do." CNA 1 said after she observed CNA 2 with his pants down at Resident 1's bedside, CNA 2 continued to work with other residents until the end of his shift. On 3/22/18 at 9:30 A.M., an interview was conducted with the Administrator (ADM). The ADM stated CNA 1 should have reported the incident on 2/7/18 immediately to her supervisor. The ADM also stated CNA 2 should have been suspended immediately. Per the Facility's Policy, Resident Alleged Abuse Policy and Procedures, dated May 1, 2013... "Any person having information either by direct observation or by report, of any act, suspected act or injury of unknown origin that may be considered abuse is responsible to immediately report the information to the administrator, charge nurse or supervisor regardless of time of day." FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 0JTT11 Facility ID: CA080000099 If continuation sheet 6 of 10 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555246 (X3) DATE SURVEY COMPLETED 06/18/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE VISTA VIEW POST ACUTE 304 N Melrose Dr Vista, CA 92083 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG

F609 Reporting of Alleged Violations CFR(s): 483.12(c)(1)(4)

F609 SS=D PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE §483.12(c) In response to allegations of abuse, neglect, exploitation, or mistreatment, the facility must: §483.12(c)(1) Ensure that all alleged violations involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities) in accordance with State law through established procedures. §483.12(c)(4) Report the results of all investigations to the administrator or his or her designated representative and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of the incident, and if the alleged violation is verified appropriate corrective action must be taken. This REQUIREMENT is not met as evidenced by: The facility failed to ensure a Certified Nursing Assistant (CNA 1), reported an observation of possible staff to resident abuse by CNA 2, immediately to the facility's abuse coordinator. As a result, the facility failed to notify the FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 0JTT11 Facility ID: CA080000099 If continuation sheet 7 of 10 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555246 (X3) DATE SURVEY COMPLETED 06/18/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE VISTA VIEW POST ACUTE 304 N Melrose Dr Vista, CA 92083 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE Department of the allegation within 24 hours, as required per regulation. Findings: On 2/8/18 at 1:27 P.M., the Director of Nursing (DON) reported to the Department an allegation of staff to resident abuse. The DON was interviewed by telephone on 2/8/18 at 2:45 P.M. According to the DON, on the night shift on 2/7/18, a Certified Nursing Assistant (CNA 1) observed CNA 2, at a resident's bedside, with his pants down around his ankles. Per the same interview, the resident, who had advanced dementia, was on the bed facing away from CNA 2 with the bed raised to waist level. The DON also stated although the incident occurred at 4 A.M. in the morning of 2/7/18, she was not informed until 2/8/18. On 2/8/18 at 4:30 P.M., the Department made an unannounced visit to investigate the reported alleged abuse. On 3/1/18 at 1:35 P.M., an interview was conducted with CNA 1. CNA 1 stated on 2/7/18 at approximately 3:45 A.M., she went to Resident 1's room to deliver a letter to CNA 2. CNA 1 stated she was in the hallway outside of Resident 1's room when she overheard Resident 1 state she was cold and asked for her blanket to be put back on. CNA 1 stated when she entered the resident's room, she observed Resident 1 in the bed next to the window. CNA 1 noticed Resident 1's curtain was pulled to the end of the resident's bed, obscuring the view of the resident from the doorway. Below the curtain CNA 2's pants were around his ankles while he stood facing Resident 1's bed. CNA 1 stated she walked around the curtain to CNA 2 to deliver the FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 0JTT11 Facility ID: CA080000099 If continuation sheet 8 of 10 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555246 (X3) DATE SURVEY COMPLETED 06/18/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE VISTA VIEW POST ACUTE 304 N Melrose Dr Vista, CA 92083 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE letter. CNA 1 stated Resident 1's bed was raised to the same level as CNA 2's waist as he stood there with his pants around his ankles. CNA 1 stated Resident 1 was awake, naked from the waist down and on her left side facing away from CNA 2. CNA 1 stated CNA 2 grabbed the letter from her hand and read the letter with his pants still around his ankles. CNA 1 stated she was shocked CNA 2 had his pants down and she left the room right away. CNA 1 stated she did not report what she had seen to her supervisor on 2/7/18. CNA 1 stated when she got home from her shift on 2/7/18, she called LN 1, the night supervisor, between 8 A.M and 9 A.M. CNA 1 said LN 1 was home sick when she called her. CNA 1 said she told LN 1 what she had seen and LN 1 told her she should report her observations to the DON. CNA 1 said she did not report her observations to the DON and Administrator until the next day, 2/8/17. CNA 1 said she had received abuse training from the facility and knew she should have reported the allegation of abuse immediately. CNA 1 said she did not report CNA 2 because, "I was so shocked, I forgot what to do." LN 1 was interviewed on 3/21/18 at 1:15 P.M. LN 1 said CNA 1 reported her observations to her by telephone on 2/7/18 when she was home sick. LN 1 said she called the facility later that day and left a message with the DSD to call her. LN 1 said the DSD did not return her call, so she did not report CNA 1's observations of CNA 2 to the DON until about 10 A.M. on the morning of 2/8/18. On 3/22/18 at 9:30 A.M., an interview was conducted with the Administrator (ADM). The ADM stated CNA 1 should have reported the incident on 2/7/18 immediately to her FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 0JTT11 Facility ID: CA080000099 If continuation sheet 9 of 10 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555246 (X3) DATE SURVEY COMPLETED 06/18/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE VISTA VIEW POST ACUTE 304 N Melrose Dr Vista, CA 92083 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE supervisor. The ADM stated the incident should have been reported within 24 hours to the Department. Per the Facility's Policy, Resident Alleged Abuse Policy and Procedures, dated May 1, 2013... "Any person having information either by direct observation or by report, of any act, suspected act or injury of unknown origin that may be considered abuse is responsible to immediately report the information to the administrator, charge nurse or supervisor regardless of time of day." FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 0JTT11 Facility ID: CA080000099 If continuation sheet 10 of 10