Health inspection·April 2, 2025

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a Certified Nursing Assistant (CNA 1) did not continue to have access to one of two sampled residents (Resident 1) after an allegation of physical abuse. Residents Affected - Few This deficient practice resulted in CNA 1 still being assigned to the care of Resident 1 ' s roommates after Resident 1 ' s allegation of abuse. Findings: During a review of Resident 1 ' s admission Record (Face Sheet), the Face Sheet indicated Resident 1 was admitted to the facility on [DATE] with diagnoses that included low back pain, muscle weakness (when muscles did not have the strength they normally do), and diabetes mellitus (DM- a disorder characterized by difficulty in blood sugar control and poor wound healing). During a review of Resident 1 ' s Minimum Data Set ([MDS], a resident assessment tool), dated 1/8/2025, the MDS indicated Resident 1 ' s cognition (process of thinking) was intact. The MDS indicated Resident 1 required supervision with eating; partial assistance (helper did less than half the effort) with oral hygiene and showering/bathing; substantial assistance (helper did more than half the effort) with personal hygiene and getting in-and-out of bed/ chair; and was dependent (helper did all the effort) with toileting hygiene. The MDS indicated Resident 1 used a walker and wheelchair for mobility. During a review of Resident 1 ' s History and Physical (H&P), dated 1/30/2025, the H&P indicated Resident 1 was alert and oriented to person, place, and time. During a review of Resident 1 ' s Social Service Progress Notes, dated 3/17/2025 at 5:50 p.m., the notes indicated Resident 1 informed Social Service Designee (SSD) 1 that on the night of 3/15/2025, CNA 1 hit her (Resident 1) on the back near the right shoulder followed by pressing on Resident 1 ' s back while in bed. The notes indicated Resident 1 stated she yelled for help when CNA 1 ran out of the room and closed the door behind her. The notes indicated Resident 1 reported the incident to her nurse (unidentified). During an interview on 4/1/2025 at 9:59 a.m. with Resident 1, Resident 1 stated on 3/15/2025 during the night, CNA 1 shoved her into the bed during a transfer from the wheelchair to the bed. Resident 1 stated CNA 1 pushed her and she hit her head on the side rail. Resident 1 stated CNA 1 grabbed her by the back of the legs, pushed her, and hit her on the right upper back during repositioning. Resident 1 stated while repositioning to the left side, CNA 1 squeezed her on the back. Resident 1 stated she told CNA 1 not to hit her. Resident 1 stated CNA 1 told her to be quiet and to not scream. (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 4 Event ID: 555128 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 555128 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Downey Community Health Center 8425 Iowa Street Downey, CA 90241 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)