Health inspection·April 22, 2025

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed for one of three sampled residents (Resident 1) to conduct a thorough investigation into Resident 1's allegation of abuse involving Certified Nursing Assistant (CNA 1) before allowing the alleged perpetrator to return to work. Residents Affected - Few This failure had the potential to expose Resident 1 to further abuse and compromised the integrity of the abuse investigation process. Findings: On March 28, 2025, at 10:50 a.m., an unannounced visit was made to the facility to investigate an allegation of abuse. On March 28, 2025, at 11:10 a.m., an interview was conducted with Resident 1, who stated, CNA 1 was rough while changing her brief, pushing her against the bed railing and causing pain and a bump on her left wrist on March 15, 2025. Resident 1 stated It upset me at the time. A Review of Resident 1's medical record, title, Resident Information, dated, March 18, 2025, at 11:50 a.m., indicated, resident was admitted to the facility on [DATE], with a diagnosis of hemiplegia and hemiparesis (One-sided {Left} paralysis or weakness) following a stroke. A review of Resident 1's, Brief Interview for Mental Status (a cognitive assessment), indicated a score of 15 (cognitively intact). A review of Resident 1's, Change of Condition, (A deviation from baseline condition) note, dated, March 15, 2025, at 8:00 p.m., by Licensed Vocational Nurse (LVN) 1, indicated, . (Resident 1 . accusing {CNA 1} being rough while changing (resident), (Resident 1) complained of a bump (on) left wrist . (LVN 1 assessed Resident 1's left wrist) bone, no noted (injuries) skin intact, no discolorations . (CNA 1) stated she was not rough with (resident) and had . (CNA 2) with her, while changing Resident 1 . (LVN 1) . notified . Director of Nursing (DON) and Administrator ({Admin}-Abuse Coordinator) . DON informed all staff to take a second person at all times caring for (Resident 1) . Police officer arrived and spoke to (LVN 1) . (Resident 1) and (Admin). (Admin) called (the facility) and tried to speak to (Resident 1) twice and (resident) said No I'm not talking to (Admin) . On March 28, 2025, at 1:18 p.m., an interview was conducted with CNA 1, who stated, she worked double shift on March 15, 2025, and cared for Resident 1 in the morning without incident. CNA 1 stated she was informed on March 15, 2025, at 9:23 p.m. (one hour after the allegation was reported), that she could return to work the next morning, March 16, 2025 at 6:30 a.m. (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: 555383 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 555383 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Blythe Post Acute LLC 285 West Chanslor Way Blythe, CA 92225 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)