Health inspection·July 11, 2023

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on interview and record review, the facility failed to ensure an allegation of sexual abuse was reported to the State Agency within the regulatory time frame for one resident (Resident 1) of three sampled residents. This failure had the potential to delay the investigation of the alleged abuse. Findings: A review of Resident 1 ' s Face Sheet indicated she was readmitted to the facility December 2022 with diagnoses including unspecified dementia (a mental disorder in which a person loses the ability to think, remember, learn, make decisions, and solve problems) and muscle weakness. A review of Resident 1's Minimum Data Set (MDS- an assessment tool) Cognitive Patterns, dated 3/17/23, indicated she had moderate cognitive impairment. A review of Resident 1 ' s IDT [Interdisciplinary Team] Notes dated 6/20/23 at 10:33 a.m., indicated, Resident noted with an incident with peer at around 2245 [10:45 p.m.] on 6/19/2023 as documented by Nursing staff. CNA and Nursing staff noted peer kneeling at left side of her bed, with his hands under her bedsheet, and with Resident's left leg noted to be uncovered . During a telephone interview on 6/28/23 at 5:06 p.m., with the Licensed Nurse (LN), the LN stated, on 6/19/23 at around 10:40 p.m., they found Resident 2 kneeling on the side of Resident 1 ' s bed, Resident 2 stated he was trying to make love with his wife. The LN stated, she reported the incident to the Police Department and the Ombudsman within two hours but could not remember if she sent the Fax to the State Agency that time. She stated she sent the report to the State Agency in the morning of 6/20/23. A review of the report from the facility indicated, the report was faxed to the State agency on 6/20/23 at 8:41 a.m., 10 hours after the alleged sexual abuse occurred. During a concurrent interview and record review on 6/27/23 at 11:09 a.m., with the Director of Nursing (DON), the DON acknowledged that the facility report transmission verification report indicated that the report was faxed to the State Agency on 6/20/23 at 8:41 a.m., but the incident occurred during the night shift of 6/19/23. He stated, the facility tries to report alleged abuse cases as soon as possible depending on the case. He acknowledged that all alleged abuse cases should be reported to appropriate agencies within two hours of the incident. Page 1 of 2 555049 555049 07/11/2023 Lodi Nursing & Rehabilitation 1334 S. Ham Lane Lodi, CA 95242

F 0609 Level of Harm - Minimal harm or potential for actual harm A review of the Facility's Policy titled, ABUSE PREVENTION, Revised 1/13, indicated, .REPORTING . 9. Administrator/ Designee will investigate all suspected or alleged abuse and report the incident immediately and no later than two hours to the Local Law Enforcement Agency, Licensing and Certification Program and Ombudsman ' s Office by telephone and in writing using [facility report form] . Residents Affected - Few 555049 Page 2 of 2