Health inspection·February 12, 2025

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to follow its abuse prevention policy and procedures when one of one sampled resident (Resident 1) reported an incident of alleged physical abuse by staff, but the facility had no evidence it conducted an investigation nor reported the results of the investigation to the State Department of Health (the Department) within 5 working days. Residents Affected - Few This failure had the potential to delay the Department ' s independent investigation of the incident. Findings: Review of Resident 1 ' s nurse's progress note, dated 10/29/2024 at 10:15 p.m., indicated, Resident [1] stated to the LN [licensed nurse] the CNA [certified nursing assistant] from last time [10/28/24] pulled on her arms and gave her a 2.5cm x 2 cm discoloration to her left hand near thumb . During a concurrent interview and record review on 2/12/25 at 3:20 p.m., with Medical Record Staff (Staff D), Resident 1's electronic medical record was reviewed. Staff D stated Resident 1's medical record contained a nurse's note dated 10/29/24 at 10:15 p.m. documenting the alleged abuse. Staff D also confirmed the medical record did not contain any additional nurse's notes nor IDT (interdisciplinary team of healthcare professionals including nursing, social workers, pharmacy, and dietary staff) notes addressing the alleged abuse incident or investigation of the incident. During a telephone interview on 2/13/25 at 2 p.m., AA stated she was unable to produce documentation of an IDT meeting, nor a 5-day investigation summary related to Resident 1 ' s alleged abuse incident. During a telephone interview on 2/14/25 at 10:15 a.m., AA stated when there is an allegation of abuse, the facility would interview all parties involved (including the family, resident, and staff), the incident would be discussed in IDT meetings, IDT meeting notes would be stored in a file of the in-house investigations, and social service staff would document investigation notes in the resident ' s medical record. AA confirmed the facility did not have any documentation related to an in-house investigation, nor IDT notes regarding the incident, nor any social service documentation related to the incident in Resident 1's medical record. AA added, the Administrative staff and the Director of Nursing were responsible for providing the 5-day investigation summary to the Department and confirmed the 5-day investigation summary should have been completed. Review of facility policy titled, Abuse and Neglect - Clinical Protocol, subtitled, Cause Identification, revised March 2022, the policy indicated, .1. The staff .will investigate alleged abuse and Page 1 of 2 555207 555207 02/12/2025 Piners Nursing Home 1800 Pueblo Ave Napa, CA 94558

F 0610 neglect to clarify what happened and identify possible causes . Level of Harm - Minimal harm or potential for actual harm Review of facility policy titled, Abuse, Neglect, Exploitation and Misappropriation Prevention Program, subtitled, Policy Interpretation and Implementation, revised April 2021, indicated, . 8. Identify and investigate all possible incidents of abuse . 9. Investigate and report any allegations within timeframes required by federal requirements . Residents Affected - Few 555207 Page 2 of 2