Health inspection·July 16, 2024

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 ensure staff reported in a timely manner an allegation of abuse to the facility's administration including the California Department of Public Health (CDPH- the State Survey and Certification Agency) for one resident (Resident 1) This deficient practice had the potential for a repeat abuse allegation for Resident 1, and for all other residents to be unprotected from abuse. Resident 1 was admitted to the facility on [DATE] with diagnoses including metabolic encephalopathy (a problem in the brain caused by a chemical imbalance in the blood) according to the facility's admission Record. The admission MDS (a clinical assessment tool) dated 5/16/24, listed a cognitive score of 7, indicating Resident 1 was severely impaired. During an observation and interview with Resident 1 on 7/11/24, at 12:14 P.M., Resident 1 was observed lying in bed. Resident 1 stated there were four females who pulled her around on the back of her shirt and started beating on her. Resident 1 stated she did not remember what the females looked like. The Director of Nurses (DON) was interviewed on 7/11/24 at 12:50 P.M. The DON stated on 6/27/24 she received report from licensed nurse (LN) 2 regarding certified nurse assistant (CNA) 3 who witnessed an abuse. The DON stated CNA 3 witnessed CNA 4 pulled and punched Resident 1 on the left side of her face three times on 6/25/24. The DON stated on 6/26/24 CNA 3 witnessed CNA 4 squeeze Resident 1's face and pushed Resident 1 back to her bed while squeezing Resident 1's face. The DON stated she was not aware of the first incident on 6/25/24 and CNA 3 should have reported the incident immediately according to the facility's policy. The DON further stated if abuse allegations were not reported, the resident could suffer because the perpetrator should be pulled out of schedule to protect the resident. A phone interview on 7/12/24 at 7:36 A.M. was conducted with CNA 3. CNA 3 stated she worked with CNA 4 on 6/25/24, night shift. CNA 3 stated Resident 1 was on one-on-one monitoring (providing one to one observation of resident for a period of time). On 6/25/24 CNA 3 stated CNA 4 responded to an alarm from Resident 1's room. CNA 3 stated she also went to Resident 1's room and while at the doorway, CNA 3 stated she saw Resident 1 sitting in the wheelchair in front of the sink and CNA 4 slapped Resident 1 three times on the left face. CNA 3 stated there was blood in the soap dispenser, bed rail and the floor. CNA 3 stated Resident 1 had a cut on the right hand and Resident 1 continued to be (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: 555290 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 555290 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/16/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071 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)