Health inspection·June 2, 2023

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure their policy and procedure (P&P) for abuse was implemented when a licensed nurse did not report an injury of unknown origin in a timely manner for one of four sampled residents (Resident 1) in a universe of 15 residents. This failed practice had the potential for other unusual occurrences (an incident that threatens the welfare, safety, and health of the resident) to go undetected and unreported which could compromise the health and safety of residents at the facility. Residents Affected - Few Findings: During a review of a notification from the Director of Nursing (DON) to the California Department of Public Health (CDPH), dated May 20, 2023, the notification indicated, Resident 1 was a [AGE] year-old female with a history of Dementia (progressive loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often personality change, resulting from disease of the brain), Depression (mental illness affecting how you feel, the way you think and how you act), and stroke (Blood flow to the brain is blocked resulting in injury causing effects such as emotional disturbances, ability to speak and understand, and ability to move limbs). A further review of the document indicated, the DON was notified by Licensed Vocational Nurse (LVN1) about an injury of unknown origin on May 20, 2023, at 7:15 AM. Resident 1 was assessed to have a bruise (to develop or bear discolored spot on the skin as the result of blow or fall) under her left arm that wrapped around under her breast to the front of her chest. Resident 1 stated she does not remember doing anything to cause the bruise. During an interview on May 23, 2023, at 11:38 AM, with the DON, the DON stated, Resident 1's bruising was assessed on May 18, 2023, during the day shift. The DON stated when LVN1 and Certified Nursing Assistant (CNA1) found it was fresh bruise. The DON further stated, LVN 1 did not document and did not call doctor. During an interview on May 23, 2023, at 12:03 PM, with LVN1, LVN1 stated she found the bruise on May 18, 2023. LVN1 stated, I forgot to chart it. I wrote a note to (DON) via email on May 20, 2023. I did not notify the doctor at that time. It was during med (mediaction) pass and other things happening and I did not (follow policy and procedure). Expectation is to be more aware of my charting and following protocol on change of condition. During a concurrent observation and interview on May 23, 2023, at 12:24, with Resident 1, Resident 1 had no psychosocial distress or visible injuries observed, Resident 1 stated, I don't know (how long she has been Here). I don't know (why she is here). Resident stated the staff here are ok and denied residents or staff have hurt her. Resident 1 verbalized first name, but last name verbalized was Page 1 of 2 555468 555468 06/02/2023 Bear Valley Community Hospital 41870 Garstin Rd Big Bear Lake, CA 92315

F 0607 incorrect. Resident 1 was unable to recall bruising or the cause. Level of Harm - Minimal harm or potential for actual harm During an interview on May 23, 2023, at 12:32 PM, with Certified Nursing Assistant (CNA 1), CNA1 stated, I found it (bruising) Thursday 18th on the day shift. I called the nurse (LVN1) in charge. LVN1 assessed the bruise and spoke to the resident and asked the resident to how she was feeling and how she may have gotten hurt in that area. Resident told (LVN1) she doesn't remember. Residents Affected - Few During a concurrent interview and record review on May 23, 2023, at 1:32 PM, with the DON, the facility's policy and procedure (P&P) titled, Adult/Elder Abuse - SNF , undated, was reviewed. The P&P indicated, .6. BVCHD shall identify and investigate all suspicions or allegations of abuse (such as suspicious bruising of residents .); reviewing occurrence, patterns and trends that ma to they constitute abuse shall be used to determine the direction of the investigation .8. All allegations of abuse shall be reported immediately to the Administrator on Call (AOC), state agency, adult protective services and/or to all other required agencies. 8.1. The employee who witnessed the incident shall report to administration immediately, or at the earliest practical time, The DON stated, the facility's staff did not follow the indicated portion of the policy and procedure. 555468 Page 2 of 2