Health inspection·April 9, 2024

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, medical record review, facility document review and facility P&P review, the facility failed to remove a staff (CNA 1) from resident care areas pending an alleged violation of abuse for one of two sampled residents (Resident 1) as per the facility's P&P. This failure had the potential to expose Resident 1 to abuse. Residents Affected - Few Findings: Review of the facility's P&P titled Reporting Allegations of Abuse/Neglect/Exploitation revised 10/21/22, showed under the Procedure for Response and Reporting Allegations of Abuse/Neglect/Exploitation section, when thereports of abuse/neglect/exploitation occur, the following procedure will be initiated: 1. The Licensed Nurse will: a. Respond to the needs of the resident and protect him/her from further incident. b. Remove the accused employee from resident care areas. 2. The Administrator or designee will: c. Suspend the accused employee pending completion of the investigation. Review of the facility's SOC 341 (a form to report suspected abuse) dated 4/8/24, showed the facility reported Resident 1 reported to a staff that CNA 1 hit her left shoulder on 4/7/24 at 2000 hours. Medical record review for Resident 1 was initiated on 4/9/24. Resident 1 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of the facility Census dated 4/7/24, showed Resident 1 was in room [ROOM NUMBER]A. Review of the facility's Nursing Assignment Sheet on 4/7/24, for the PM shift from 1500 to 2300 hours, showed CNA 1 was assigned to Rooms 406B and 417A to 419B. On 4/9/24 at 1120 hours, a telephone interview was conducted with CNA 1. When asked about the abuse allegation related to Resident 1, CNA 1 verified she provided care for Resident 1 on 4/7/24. CNA 1 was asked if she was sent home on 4/7/24, pending the investigation of the abuse allegation with Resident 1. CNA 1 stated after the allegation reported, she was reassigned to care for another resident (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: 555141 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 555141 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/09/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Town & Country 555 East Memory Lane Santa Ana, CA 92706 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)