Health inspection·March 19, 2024

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 interview and record review, the facility failed to ensure residents were free from physical abuse for one out of three residents (Resident 1) when Resident 2 (who was of moderate mental capacity) slapped Resident 1 in the mouth causing injury to Resident 1's top lip and first aid being administered. Resident 2's act of slapping Resident 1 in the mouth was a deliberate act to inflict harm or injury, not accidental; therefore, his action was deemed as a willful act and considered abuse. This failure had the potential of both physical and emotional harm to all residents. Findings: On 10/17/22, the facility submitted a facsimile (FAX, a telephonic transmission of scanned printed material) to the California Department of Public Health (CDPH) about an incident between Residents 1 and 2. The FAX indicated Resident 2 slapped Resident 1 in the mouth and Resident 1 sustained a minor injury of the upper gingiva (gums) and upper lip. Review of Resident 1's clinical record indicated she had diagnoses which included metabolic encephalopathy (a problem in the brain caused by a chemical imbalance in the blood), sepsis (an infection in the blood). Review of Resident 2's clinical record indicated he had diagnoses which included schizoaffective disorder (mental disorder including schizophrenia [serious mental disorder in which people cannot distinguish reality] and mood disorder) and bipolar disorder (mental illness which a person can experience mood swings [period of overly happy or periods of feeling sad). Review of the facility's 5-day summary report, dated 10/19/22, indicated, on 10/15/22 at 12:10 p.m., staff were bringing residents in the dining room and found Resident 1 placing her hand on mouth. The 5-day summary report further indicated Resident 1 had a slight upper lip bleeding. Residents in the dining room witnessed Resident 2 slapping Resident 1 after a verbal altercation (argument). Review of Resident 2's IDT Progress Notes-Behavior Management, dated 10/17/22, indicated, on 10/15/22 Resident 2 went to the dining room, pulled a chair out from a table which made a loud noise. The noise had agitated Resident 1 and she made a comment to Resident 2 to pick up your chair. Resident 2 walked over to Resident 1 and stated Please don't say that sh** and Resident 1 had responded back you have so much anger in you, why don't you just hit me. Resident 2 proceeded to slap Resident 1 in the mouth causing Resident 1 to bleed form her lip. Review of Resident 1's skin assessment, dated 10/15/22, indicated she had pain with an intensity of (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: 555060 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 555060 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor the Ridge Rehabilitation Center 350 Iris Drive Salinas, CA 93906 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)