Health inspection·December 11, 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one of three sampled residents (Resident 1) was free from abuse when his arm was held down by a Certified Nurse Aide's (CNA) knee while attempting to dress him. This failure resulted in Resident 1 being subjected to physical abuse, which had the potential to result in physical injury, emotional and psychological distress. Findings: On December 11, 2023, at 8:54 a.m., an unannounced visit was conducted at the facility to investigate a facility reported incident involving Resident 1. A review of Resident 1's admission record indicated he was admitted to the facility on [DATE], with diagnoses including hemiplegia (paralysis of one side of the body) and hemiparesis (one-sided muscle weakness), history of falling, cerebral infarction (stroke) and expressive language disorder (a problem with language communication). The MDS (Minimum Data Set, an assessment tool), dated October 1, 2023, indicated Resident 1 had severe cognitive impairment and unclear speech. A review of Resident 1's History and Physical record dated February 10, 2023, indicated Resident 1 does not have the capacity for decision making. A review of Resident 1's SBAR (Situation, Background Assessment and Recommendation) report dated November 28, 2023, indicated, .CNA reported to this nurse while providing care to resident, resident then struck CNA in face. CNA held resident ' s arms down with knee. CNA was then approached by housekeeping nearby who told her to get help to provide care. CNA then left room at that point . On December 11, 2023, at 11:35 a.m., an interview was conducted with a facility housekeeper (HK). The HK stated On November 28, 2023, between 6:45 a.m., and 7:00 a.m., she observed CNA 4 trying to put the shirt on Resident 1. The HK stated the resident ' s left arm was extended, and the CNA had her left knee on the resident ' s arm. The HK stated, I told the CNA to ask for someone to help her. The HK stated the CNA ' s stated that other staff were busy. The HK stated, .I said to tell the nurse about it, but she continued to attempt to put on the shirt on him with her knee on top of his arm. I asked the CNA to please take her knee off his arm and the CNA responded in other places she got hit before by resident and she was not going to let this patient hit her. The HK stated, I asked again (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: 555403 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 555403 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/11/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Monterey Palms Health Care Center 44610 Monterey Avenue Palm Desert, CA 92260 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)