Health inspection·May 30, 2023

F 0600 Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure one of three sample residents (Resident 1), was not physically abused. Licensed Vocational Nurse (LVN) 1 punched Resident 1 in the face. This deficient practice resulted in Resident 1 developing a swollen and bruised left eye. Findings: During a review of Resident 1 ' s admission Record (Face Sheet), the admission Record indicated, Resident 1 was admitted to the facility on [DATE] with diagnoses including schizophrenia (serious mental disorder in which people interpret reality abnormally), anxiety disorder (feeling of worry or fear), and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest and can interfere with daily living). During a review of Resident 1 ' s History and Physical (H&P), dated 2/19/2023, the H&P indicated, Resident 1 had the capacity to understand and make decisions intermittently related to acute psychosis (a clinical syndrome that involves hallucinations [perception of something not present], delusions [unable to tell what is real from what is imagined], disorganized thoughts or behaviors, or some combination within an acute timeframe often less than 1 month). During a review of Resident 1 ' s Minimum Data Set ([MDS] a standardized care screening and assessment tool), dated 2/26/2023, the MDS indicated Resident 1 had the capacity to understand and be understood intermittently. The MDS indicated Resident 1 had trouble concentrating, no physical behavioral symptoms directed toward others, and verbal behavioral symptoms directed toward others. The MDS indicated Resident 1 required supervision with activities of daily living ([ADL] activities related to personal care) when walking in corridor and toileting. During a review of Resident 1 ' s Nurses Notes, dated 4/21/2023, indicated on 4/21/2023 at 3:00 a.m., Resident 1 was making loud noises in the hallway with Resident 4. LVN 1 intervened and separated the two residents (Resident 1 and Resident 4). Nurses Notes indicated on 4/21/2023 at 3:45 a.m., Resident 1 followed LVN 1 to the nurse station and started talking about shooting people and LVN 1 tried to calm down Resident 1 by asking him to go to his room then Resident 1 hit LVN 1 in the mouth. On 4/21/2023 Resident 1 was escorted to his room without any incidents. During a review of Resident 1 ' s Situation, Background, Assessment, and Recommendation ([SBAR] communication form) form, dated 4/21/2023, indicated Resident 1 had a change of condition ([COC] a clinical deviation from a resident's baseline) with symptom, or sign observed and evaluated with a black Page 1 of 4 555368 555368 05/30/2023 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0600 eye (an area of bruised skin around the eye resulting from a blow). Level of Harm - Actual harm During a review of Resident 1 ' s Interdisciplinary Care Plan, titled Alteration in Skin Integrity, dated 4/21/2023, indicated, Resident 1 had left lower eyelid slight discoloration measuring 0.3 x ([by] proximity of measurement) 0.5 centimeters ([cm] unit of measurement). Residents Affected - Few During a review of Resident 1 ' s Interdisciplinary Care Plan titled, Aggressive Behavior (behavior that is intended to harm another individual who does not wish to be harmed) dated 4/21/2023, the care plan indicated Resident 1 had an incident with staff, Resident 1 was anxious, restless and had delusional behavior (having false or unrealistic beliefs or opinions). Care plan indicated Resident 1 stated he had a fight with someone where he was screaming, yelling, and should be shooting unnamed resident. The care plan indicated Resident 1 stated he was fighting like animal, hit unnamed person and someone wearing a green and black jacket hit him (Resident 1). During a review of Certified Nurse Assistant (CNA 2) interview record (written statement) regarding the incident that happened on 4/21/2023, CNA 2 indicated he heard loud yelling coming from Nursing Station 1 and saw Resident 1 and LVN 1 were engaged in verbal confrontation. CNA 2 indicated Resident 1 called LVN 1 a racial remark Ni er and hit LVN 1 in the mouth. CNA 2 put himself in between Resident 1 and LVN 1 to de-escalate the situation with his hands up and palms open to let Resident 1 know he was not trying to be the aggressor. Resident 1 took some steps back and was focused on CNA 2, then LVN 1 ran from behind CNA 2 and tackled Resident 1 to the floor. CNA 2 stated while Resident 1 was on his back on the floor, LVN 1 put his knees on each one of Resident 1 arms to keep Resident 1 still on the floor and started to strike Resident 1 across his face. CNA 2 indicated the tackle was not needed because he (CNA 2) was already in between Resident 1 and LVN 1 to deescalate the situation. During an observation on 5/4/2023 at 11:00 a.m., Resident 1 was in hallway near his (Resident 1) room, Resident 1 was observed with swelling and bruising around his left eye. During a telephone interview on 5/4/2023 at 2:00 p.m., with CNA 2, CNA 2 stated he witnessed Resident 1 and Licensed Vocational Nurse (LVN) 1 arguing and heard Resident 1 call LVN 1 a racial remark Ni er. CNA 2 stated Resident 1 was observed in a fighting posture and LVN 1 told Resident 1 you are not going to do anything. CNA 2 stated he saw Resident 1 hit LVN 1 in the mouth, then CNA 2 (with his hands up in a non-aggressive gesture) stood in between Resident 1 and LVN 1 to stop Resident 1 from hitting LVN 1. Resident 1 stopped hitting LVN 1. Resident 1 stepped away from LVN 1 then LVN 1 tackled Resident 1 to the ground and slapped Resident 1 in the face. CNA 2 stated Resident 1 fought back and tried to kick LVN 1 off him. CNA 2 stated LVN 1 should know that Resident 1 was a psychiatric (having mental illness) patient and should not hit Resident 1. During a telephone interview on 5/4/2023 at 3:00 p.m., with LVN 1, LVN 1 stated, he was the charge nurse the night of 4/21/23 at 3:00 a.m. and was assigned to Resident 1. LVN 1 stated, Resident 1 was fixated with Room A and he (LVN 1) asked Resident 1 to move away from the room. LVN 1 tried to make Resident 1 go to his room but instead of going back to his room, Resident 1 followed him (LVN 1) to the nursing station and yelled an inappropriate racial comment Ni er. and hit him (LVN 1) in the mouth and neck. LVN 1 stated he tried to block the hits and moved away from Resident 1. LVN 1 stated Resident 1 stopped hitting him and walked back to his room. LVN stated he should have run for his life, de-escalated (reduce the potential for violent situation), and redirected Resident 1. LVN 1 stated he never hit him (Resident 1). 555368 Page 2 of 4 555368 05/30/2023 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0600 Level of Harm - Actual harm Residents Affected - Few During an interview on 5/4/2023 at 3:40p.m., with the Director of Staff Development (DSD), the DSD stated she interviewed the staff and Resident 1. The DSD stated CNA 2 reported LVN 1 hit Resident 1 in the face. Resident 1 admitted hitting LVN 1 and said, The staff (LVN 1) punched him back. CNA 2 and Resident 1 statements were aligned about Resident 1 being hit by LVN 1. The DSD stated LVN 1 denied hitting Resident 1 and said he was hit by Resident 1. The DSD stated Resident 1 presented with discoloration of the left eye lid that morning. Resident 1 should not have been hit by staff or anyone. The DSD stated LVN 1 resigned on 4/24/23. During an interview on 5/4/2023 at 3:55 p.m., with the Director of Nursing (DON) regarding the incident that happened on 4/21/2023, the DON stated LVN 1 reported Resident 1 had aggressive behavior and hit LVN 1 during the night shift. The DON stated during rounds on 4/21/12 at 6:00 a.m., she noticed Resident 1 left eye was discolored. The DON stated she asked Resident 1 what happened, and Resident 1 said, he hit someone, and someone hit him back. The DON stated, LVN 1 stated he does not know what happen to Resident 1 ' s eye. The DON stated CNA 2 was called by the DSD and was told Resident 1 hit LVN 1, and LVN 1 charged Resident 1 to the floor and punched Resident 1 in the face. The DON stated it was not okay for staff to hit residents. It was important to give good customer service and abusive behavior (a wide range of actions, words, and behaviors that are intended to control, manipulate, or harm another person) was not tolerated at the facility. During an interview on 5/4/2023 at 4:15 p.m., with the Administrator (ADM), the ADM stated, CNA 2 reported Resident 1 punched LVN 1 and LVN 1 hit Resident 1 in the face. The ADM stated the DON was doing rounds in the morning and noticed the discoloration to Resident 1 ' s left eye. The ADM stated CNA 2 reported LVN 1 hit Resident 1 in the face. Resident 1 was sent to the hospital on 4/21/2023. The ADM stated it was not okay to hit residents and abusive behavior was not tolerated. During a concurrent interview and record review on 5/30/2023 at 3:15 p.m., with the DON, Resident 1 ' s Nurses Notes, dated 4/21/2023 was reviewed. Nurses Notes indicated Resident 1 stated he had a fight where he fought like an animal, he was screaming, yelling and should shout and shoot him (did not name who). Nurses ' notes indicated Resident 1 stated he hit them (did not indicate who) but he (did not specify name) hit him. The DON stated he asked Resident 1 who hit him, and Resident 1 stated he does not know, he was wearing a green uniform and black jacket. Nurses ' notes indicated at around 7 a.m., slight discoloration was noted on Resident 1 ' s lower left eye lid. The DON stated, she was doing rounds that morning and noticed discoloration to Resident 1 ' s left eye. During a review of the facility ' s policy and procedure (P&P) titled, Charge Nurse-RN/LVN Job Description, undated, the P&P indicated, The primary purpose of your job position was to provide direct nursing care to the residents and to supervise the day-to-day nursing activities performed by the certified nursing assistants. All care and supervision must be in accordance with current federal, state, and local standards, guidelines, regulations, and laws that govern our facility .Complies with abuse prevention & reporting policies and procedures. During a review of the facility ' s policy and procedure (P&P), titled Promoting/Maintaining Resident Dignity, dated (2022), indicated, It is the practice of this facility to protect and promote resident rights and treat each resident with respect and dignity as well as care for each resident in a manner and in an environment, that maintains or enhances resident ' s quality of life by recognizing each resident ' s individuality. During a review of the facility ' s P&P, titled Abuse, Neglect and Exploitation (the action or fact of treating someone unfairly in order to benefit from their work), dated 2023, indicated, Each 555368 Page 3 of 4 555368 05/30/2023 Century Villa, Inc 301 Centinela Ave Inglewood, CA 90302

F 0600 Level of Harm - Actual harm Residents Affected - Few resident has the right to be free from abuse, neglect, misappropriation of resident property and exploitation. Residents must not be subject to abuse by anyone, including, but not limited to; facility staff, other residents, consultants, contractors, volunteers, or staff of other agencies serving the resident, family members, legal guardians, friends, or other individuals . Physical abuse includes, but is not limited to hitting, slapping, pinching, and kicking. 555368 Page 4 of 4