Health inspection·July 23, 2024

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to provide evidence that an allegation of abuse was thoroughly investigated for one of three residents (Resident 1). Residents Affected - Few This failure had the potential for further abuse to occur to residents. Findings: During a review of Resident 1's History and Physical (H&P), dated June 29, 2024, the H&P indicated the following diagnoses: atrial fibrillation (irregular and fast heart rhythm), cancer at base of tongue, metastatic (spreads to other areas) squamous cell carcinoma (cancer that starts on skin surface) to head and neck, palliative care (specialized medical care for people with incurable illness), percutaneous endoscopic gastrostomy tube (a tube to allow a person to get nutrition through the stomach), trismus (mouth remains tightly closed). During a review of Resident 1's Nursing Progress Note (NPN), dated 7/12/24 at 11:00 p.m., the NPN indicated, in part, Patient reported to nurse during rounds that (Resident 1) feels everyone here hates (Resident 1), and (Resident 1) feels (Resident 1) does not deserve to be treated that way, but (Resident 1) did not want to mention any names. I did let patient know that I would be reporting this to my charge nurse . During a review of Resident 1's Nursing Progress Note (NPN), dated 7/12/24 at 11:30 p.m., the NPN indicated, in part, Patient verbalized, ' I'm going to die soon probably in less than 3 months and I don't want to die feeling like everyone hates me .' The NPN further indicated law enforcement, the ombudsman, California Department of Public Health (CDPH), Adult Protective Services (APS), Director of Sub-Acute (DSU) and Licensed Nurse (LN 9) were all notified. During a telephone interview on 8/1/24 at 1:10 p.m. with the Director of Sub-Acute (DSU), the DSU was asked if the 5 day report was completed. The DSU stated, Who does that? During review of an email correspondence with the DSU on 8/1/24 at 3:42 p.m., the email from DSU indicated, There was never a 5 day investigative report sent from quality, legal and reporting because it was not considered an abuse case. During a review of the facility's policy and procedure (P&P) titled, Prevention of abuse, Neglect and Exploitation of Residents Sub-Acute Facility, revised date 3/28/24, the P&P indicated, in part, Report the results of all investigations in writing to the administrator or his or her designated representative and to other officials in accordance with state law, including to the State Survey Agency within 5 working days of the incident . and The Quality and Risk Management Department will submit Page 1 of 2 555223 555223 07/23/2024 St. John's Hospital Camarillo D/P Snf 2309 Antonio Avenue Camarillo, CA 93010

F 0610 the 5 day report to the State Department (CDPH) . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 555223 Page 2 of 2