Health inspection·November 7, 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to report an abuse allegation within 2 hours for one of three residents (Resident 2). This deficient practice had the potential to result in additional harm to Resident 2 as evidenced by a bruise to the resident's left upper cheek (below the eye). Findings: During a record review of Resident 2 ' s admission Record, dated 10/31/2022, the admission Record indicated Resident 2 was admitted to the facility on [DATE]. Resident 2 ' s diagnoses included dementia (a condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change, resulting from organic disease of the brain). During a record review of Resident 2 ' s Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 7/29/2023, the MDS indicated Resident 2 was severely cognitively impaired (ability to think and reason). The MDS indicated Resident 2 required extensive assistance (resident involved in activity; staff provide weight-bearing support) for eating, toilet use, personal hygiene, and total dependence (full staff performance every time) for dressing. During a record review of Resident 2 ' s History and Physical (H&P), dated 10/7/2023, the H&P indicated Resident 2 did not have the capacity to understand and make decisions. During a record review of Resident 1 ' s admission Record, dated 10/31/2023, the admission Record indicated Resident 1 was admitted to the facility on [DATE]. Resident 1 ' s diagnoses included dementia. During a record review of Resident 1 ' s MDS, dated [DATE], the MDS indicated Resident 1 was severely cognitively impaired. The MDS indicated Resident 1 required extensive assistance for dressing, eating, toileting, and personal hygiene. During a record review of Resident 1 ' s H&P, dated 6/9/2023, the H&P indicated Resident 1 could make his needs known but could not make medical decisions. During a record review of the facility's e-mail to state agency, dated 11/1/2023, sent at 10:07 a.m., the e-mail indicated the facility reported abuse to state agency 3 hours and 15 minutes after the incident (incident occurred at 6:52 a.m.) between Resident 1 and Resident 2. Page 1 of 2 555130 555130 11/07/2023 Maywood Skilled Nursing & Wellness Centre 6025 Pine Ave Maywood, CA 90270

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an observation on 11/7/2023, at 10:25 a.m., in Resident 1 ' s room, Resident 1 was observed awake, lying down in bed with his eyes closed. Resident 1 did not respond to questions or verbal stimuli. Resident 1 had a 4x4 centimeter ([cm] a unit of measurement) bruise noted on his upper left cheek, and had a small thin 0.5x2 cm bandage below his eye. During an interview on 11/7/2023, at 11:20 a.m., with Registered Nurse (RN) 1, RN 1 stated any resident abuse had to be reported to the state agency within 2 hours. During an interview on 11/7/2023, at 12:00 p.m., with the Director of Nursing (DON), the DON stated the incident between Resident 1 and Resident 2 occurred on 11/1/2023 6:52 a.m. during the 11:00 p.m. to 7:00 a.m. shift. Certified Nursing Assistant (CNA) 1 witnessed Resident 1 hovering over Resident 2 ' s bed, holding the bed control remote. The DON stated RN 2 who was in charge on 11/1/2023 during the 11:00 p.m. to 7:00 a.m. shift called him (DON) to inform the DON of the incident between Resident 1 and Resident 2. The DON stated he did not know what time the facility Administrators reported Resident 2 ' s abuse to the state agency, but knew it had to be reported within 2 hours. During an interview on 11/7/2023, at 12:56 p.m., with the Assistant Administrator (AADMIN), the AADMIN stated sometime during the previous week (11/1/2023) at 7 a.m., he received a phone call from the DON about the incident between Resident 1 and Resident 2, which he then reported to the Administrator (ADMIN). The AADMIN stated he was the one who was assigned to sending the report to state agency on 11/1/2023 for the incident between Resident 1 and Resident 2. The AADMIN stated any suspected resident abuse should have been reported within 2 hours to the state agency, but the e-mail report to state agency was sent around 10:00 a.m. due to technical difficulties with the facility's fax machine. The AADMIN stated he was unable to produce fax receipts of failed attempts to the state agency because the fax machine did not produce any. During a record review of the facility ' s policy and procedure (P&P) titled, Abuse – Reporting & Investigations, dated 3/2018, the P&P indicated the Administrator or designated representative will send a written SOC 341 (abuse reporting document) to the appropriate government agencies within 2 hours of suspected abuse. 555130 Page 2 of 2