Health inspection·March 22, 2024

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 interview and record review, the facility failed to protect the resident's right to be free from physical abuse (deliberately aggressive or violent behavior with the intention to cause harm) for two of five sampled residents (Resident 1 and Resident 2) when on 3/10/2024 Certified Nurse Assistant 2 (CNA 2) witnessed Resident 2 punch Resident 1 in the stomach area; and then Resident 1 punch Resident 2's right side of the face. This deficient practice resulted in Resident 1 and Resident 2 being subjected to physical abuse while under the care of the facility. Resident 2 sustained skin abrasions (when the surface layers of the skin have been broken) to the right side of the forehead (the part of the face above the eyes), the nose bridge (upper part of the nose) and right side of the nose crease (the part of the nose directly under the bridge) that needed first aid (initial assistance and care given to a resident who has been injured) and daily wound treatments. Findings: A review of Resident 1's admission Record indicated the facility originally admitted Resident 1 on 4/4/2023 and readmitted the resident on 2/23/2024 with diagnoses that included schizoaffective disorder (a mental illness that can affect your thoughts, mood and behavior). A review of Resident 1's Minimum Data Set (MDS - a standardized assessment and care planning tool) dated 2/29/2024 indicated Resident 1's cognition (ability to think and make decisions) was moderately impaired. The MDS further indicated that Resident 1 required supervision from staff with toileting hygiene, upper and lower body dressing, personal hygiene and with mobility (movement). A review of Resident 1's Change of Condition (COC - when there is a sudden change in a resident's health) Form dated 3/10/2024 timed at 7:05 a.m., indicated that on 3/10/2024 at 7:05 a.m., Resident 1 initiated physical aggression towards Resident 2 while in the hallway (in front of Resident 1's room). A review of Resident 1's Care Plan (untitled) dated 3/10/2024 indicated that Resident 1 was at risk for emotional distress due to Resident 1 being involved in a physical aggression with Resident 2. The goal was for Resident 1 not to have any negative outcome related to the altercation. A review of Resident 2's admission Record indicated the facility admitted Resident 2 on 12/29/2023 with diagnoses that included bipolar disorder (a mental illness that causes unusual shifts in mood, ranging from extreme highs [mania or manic episode] to lows (depression or depressive episode]), Page 1 of 3 555519 555519 03/22/2024 The Care Center on Hazeltine, LLC 6835 Hazeltine Ave. Van Nuys, CA 91405

F 0600 schizophrenia (a mental disorder in which a person interpret reality abnormally), psychosis (collection of symptoms that affect the mind, where there has been some loss of contact with reality). Level of Harm - Actual harm Residents Affected - Few A review of Resident 2's MDS dated [DATE] indicated Resident 2 had intact cognition and required supervision from staff with toileting hygiene, upper and lower body dressing, and moderate assistance from staff with mobility. A review of Resident 2's COC Form dated 3/10/2024 timed at 7:05 a.m., indicated that on 3/10/2024 at 7:05 a.m., Resident 2 received physical aggression from Resident 1. Resident 2 sustained abrasions on the right side of forehead and on the nose bridge. The COC Form further indicated Resident 2 complained of pain with a pain rating of three (3) out of 10 on a pain scale from 0 to10 (where 10 is the worst possible pain) to his lower back. A review of Resident 2's Wound Assessment Report dated 3/10/2024, timed at 10:30 a.m. indicated Resident 2 sustained the following injuries: 1. skin abrasion on the right side of forehead with a length of four (4) centimeters (cm - a unit of measurement) and a width of 0.2 cm 2. skin abrasion to the nose bridge with a length of 0.4 cm and a width of 0.4 cm 3. skin abrasion to the right side of nose crease with a length of 0.2 cm and a width of 0.2 cm. A review of Resident 2's Physician Order Summary dated 3/10/2024, indicated the following orders: 1. Right side of forehead skin abrasion: Cleanse with Normal Saline (NS - a liquid solution used to cleanse wounds) pat dry, then, apply Triple Antibiotic Ointment (a medication used to prevent and treat skin infections caused by cuts or scrapes) and leave it open to air daily for 14 days. 2. Nose bridge skin abrasion: Cleanse with NS, pat dry, then, apply Triple Antibiotic Ointment and leave it open to air daily for 14 days. 3. Right side of nose skin abrasion: Cleanse with NS, pat dry, then, apply Triple Antibiotic Ointment and leave it open to air daily for 14 days. A review of Resident 2's Care Plan (untitled) dated 3/10/2024 indicated that Resident 2 was at risk for emotional distress due to Resident 2 being involved in a physical aggression with Resident 1. The goal was for Resident 2 not to have any negative outcome related to the altercation. During an interview on 3/22/2024 at 12:03 p.m., with Resident 1, Resident 1 stated that he does not recall the date of the physical altercation but remembers a guy (referring to Resident 2) hitting him on his mouth. During an interview on 3/22/2024 at 12:20 p.m., with Resident 2, Resident 2 stated that about two weeks ago while in the facility hallway, Resident 1 punched Resident 2. During a concurrent interview and record review on 3/22/2024 at 1:04 p.m., with the Administrator (ADM) and the Director of Nursing (DON), the ADM and the DON reviewed the video feed of the facility's surveillance recording with a date and time stamped of 3/10/2024 at 6:57:39 a.m. through 3/10/2024 555519 Page 2 of 3 555519 03/22/2024 The Care Center on Hazeltine, LLC 6835 Hazeltine Ave. Van Nuys, CA 91405

F 0600 Level of Harm - Actual harm Residents Affected - Few at 7:02:00 a.m. The video recording shows Resident 2 punching Resident 1 in the stomach area with a closed fist. The video then shows Resident 1 punching Resident 2 in the face multiple times. The video then shows two staff (identified by the ADM as CNA 2 and Licensed Vocational Nurse 1 [LVN 1]) run towards Resident 1 and Resident 2 and separating the residents. The ADM stated that physical contact occurred between Resident 1 and Resident 2. During an interview with CNA 2 on 3/22/2024 at 2:02 p.m., CNA 2 stated that on 3/10/2024, CNA 2 saw Resident 1 and Resident 2 punching each other. made a closed fist and started punching each other. CNA 2 further stated this was the first time he witnessed an actual physical abuse. During a follow-up interview on 3/22/2024 at 3:38 p.m. with the DON, the DON stated that the video recording regarding the altercation on 3/10/2024 between Resident 1 and Resident 2 confirmed that physical abuse occurred between Resident 1 and Resident 2. A review of the facility's policy and procedure (P&P) titled, Abuse- Resident to Resident Altercation last reviewed by the facility on 2/27/2024, indicated, each resident has the right to be free from abuse and neglect from resident-to-resident altercations 555519 Page 3 of 3