Health inspection·July 14, 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to prevent one of three sampled residents (Resident 1) from being verbally abused when Resident 2 threatened, cursed, and yelled at Resident 1.This failure resulted in Resident 1 being scared and angry and had the potential to result in Resident 1 experiencing feelings of decreased self-worth.Findings:During a review of Resident 1's admission Record (AR), the AR indicated the facility admitted Resident 1 on 11/10/2023 with diagnoses including chronic obstructive pulmonary disease (a group of lung diseases that cause long-term breathing problems) and muscle weakness (a reduced ability of one or more muscles to exert force).During a review of Resident 1's Minimum Data Set (MDS- a resident assessment tool), dated 5/14/2025, the MDS indicated Resident1's cognitive (the ability to think and process information) skills for daily decision making were intact. The MDS indicated Resident 1 was independent (the resident completes the activity by themselves with no assistance from a helper) with toileting hygiene, partial/moderate assistance (helper does less than half the effort) with shower/bathing, upper/lower body dressing, putting on/taking off footwear, supervision or touching assistance (helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes the activity) with personal hygiene, and set up or clean-up assistance (helper sets up or cleans up, resident completes activity) with eating and oral hygiene.During a review of Resident 2's AR, the AR indicated the facility admitted Resident 2 on 10/19/2023 with diagnoses including polyneuropathy (a condition where the nerves outside of the brain and spinal cord are damaged or diseased) and muscle weakness.During a review of Resident 2's MDS, dated [DATE], the MDS indicated Resident 2's cognitive skills for daily decision making were moderately impaired (decisions poor; cues/supervision required). The MDS indicated Resident 2 required partial/moderate assistance with toileting hygiene, shower/bathing, lower body dressing and putting on/taking off footwear, set up or clean up assistance with eating, oral hygiene, and upper body dressing, and was independent with personal hygiene. During a review of Resident 2's Situation, Background, Assessment, Recommendation form (SBAR-a communication tool used by healthcare workers when there is a change of condition among the residents) dated 7/1/2025, the SBAR indicated Resident 2 displayed verbal aggression in an altercation with another resident (Resident 1). During an interview on 7/14/2025 at 10:25 am with Resident 1, Resident 1 stated Resident 1 was in the activities room with Resident 2 on 7/1/2025 when Resident 2 started yelling at Resident 1. Resident 1 stated Resident 2 wanted to fight Resident 1. Resident 1 stated Resident 1 became scared and upset after Resident 2 threatened Resident 1.During an interview on 7/14/2025 at 11 am with Resident 2, Resident 2 stated Resident 2 spoke in a raised voice to Resident 1 on 7/1/2025. During an interview on 7/14/2025 at 11:22 am with Licensed Vocational Nurse (LVN) 1, LVN 1 stated on 7/1/2025 LVN 1 heard yelling coming from the activities room. LVN 1 stated LVN 1 went into the activities room and observed Resident 2 yelling at Resident 1. LVN 1 stated after the incident LVN 1 observed Resident 1's (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: 555085 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 555085 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Claremont Manor Care Center 621 W Bonita Ave Claremont, CA 91711 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)