Health inspection·December 5, 2023

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. Based on observation, interview and record review, the facility failed to protect one of three sampled residents (Resident 1), from physical abuse when Certified Nursing Assistant (CNA) 1 slapped Resident 1 in the face. This resulted in anger, frustration and emotional distress for Resident 1 and had the potential for all residents under the care of CNA 1 to be subjected to mistreatment. Findings: A review of the facility's policy titled, Identification Types of Abuse dated 5/25/22, indicated that, Abuse prevention includes recognizing and understanding the definitions and types of abuse that can occur. It is understood by the leadership in this facility that preventing abuse requires staff education, training, and suppo1t, and a facility-wide culture of compassion and caring. Abuse is defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish. Abuse also includes the deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. Abuse includes verbal abuse, sexual abuse, physical abuse, and mental abuse including abuse facilitated or enabled through the use of technology. Physical abuse includes, but is not limited to hitting, slapping, biting, punching or kicking. On 11/01/23 at 3:30 PM, during an interview Licensed Practical Nurse (LPN) stated, .I heard a sharp scream sound and then I heard his [CNA 1] voice, it was low and about four or five words, an angry voice. According to the LPN two other staff heard and investigated the scream. At that time they were not able to determine what occurred. The LPN went on to state, [Resident 1] came to the nurses station and motioned at him [CNA 1], which is totally out of her normal self and was yelling and waiving her arms around yelling, He hit me, he hit me and that's not right. He hit me right here and pointed to her neck. She is not normally so animated and she was so upset I separated them by taking her to the other nurses station. She kept saying, he gets so mad. He hit me hard. She was tearful and adamant that he [CNA 1], hit her. On 11/02/23 at 11:20 AM, in a concurrent interview and record review, the Director of Nursing (DON) stated, She [Resident 1] said she didn't want to do what he [CNA 1] wanted, and he slapped her. She said not with a fist, but open handed. She said he was trying to take her clothes off and she didn't want to so he slapped her. The whole time her story hasn't changed. She knew he slapped her on the left side of her face . The DON also provided photos taken about an hour after the incident which showed some redness to the left side of Resident 1's face. On 11/02/23 at 12:15 PM, Resident 1 was interviewed and stated, Yes, he slapped me on the face .on the side here. Pointing to the left side of her face. Resident 1 stated, it was a while back. Page 1 of 2 555221 555221 12/05/2023 Surprise Valley Community Hospital D/P Snf 741 N. Main Street Cedarville, CA 96104

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 1 was very clear on the account of the incident and did not need any assistance in providing the information. As she relayed the facts, she would at time squint her eyes and her lips would tremble indicating stress in recollection of the event. During an interview on 11/2/23 at 1:50 PM, CNA 1 was interviewed and stated, She [Resident 1] asked why she had to change, I said because she wore the same shirt yesterday. So, she grumbled and put on the top I gave to her. Sometimes she doesn't understand so I had her sit, and I changed her pants. So, I unbraided her hair and brushed it. I went out and made coffee for her and sat at the nurse station and Resident 1 came up and said I slapped her . So, when she said that I was smiling. They said when abuse is reported by anyone, we must report it. I was doing what I was supposed to do. She was dirty and shoes were on wrong and she needed clean clothes. All that I know is that she was not happy because I had to change her. On 11/2/23 at 1:55 PM, CNA 2 was interviewed. CNA 2 stated, It was Sunday night/Monday morning. I was in another room down the hall heard a scream, I wrapped up what I was doing and asked the nurse if she heard it. She said she did and I went down and looked. No continuing commotion. So, I went back to doing what I needed to do. 555221 Page 2 of 2