Health inspection·September 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 observation, interview, medical record review, facility document review, and facility P&P review, the facility failed to thoroughly investigate an allegation of facility staff to resident physical abuse for one of three sampled residents (Resident 1) when * Resident 1 alleged that her caregiver (CNA) physically abused her. The facility staff tasked with conducting potential resident witness interviews, failed to provide the facility's Abuse Coordinator with an interview conducted with Resident 1's roommate (Resident 2), who was present during the time Resident 1 alleged to have been physically abused. This failure potentially inhibited the facility's ability to determine if resident abuse occurred and posed the risk for further abuse. Findings: Review of the facility's P&P titled Abuse, Neglect and Exploitation revised 12/19/22, showed it is the policy of the facility to provide protections for the health, welfare, and rights of each resident by developing and implementing written policies and procedures that prohibit and prevent abuse, neglect, and exploitation. An immediate investigation is warranted when suspicion of abuse, neglect or exploitation occurs. Procedures for investigations include identifying and interviewing all involved people, including the alleged victim, alleged perpetrator, and witnesses who might have knowledge of the allegation. Medical record review for Resident 1 was initiated on 9/17/25. Resident 1 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 1's MDS assessment dated [DATE], showed Resident 1 had moderately impaired cognition. On 9/17/25 at 1550 hours, an observation and concurrent interview was conducted with Resident 1. Resident 1 was observed in her room lying in her bed. Resident 1 stated approximately two weeks ago, on the night shift, her caregiver slapped her on the face, choked her, and squeezed her hands, resulting in pain to her hands. Resident 1 described the caregiver as being a female with blonde hair. Resident 1 stated she reported the incident to the facility staff. Resident 1 stated her roommate (Resident 2) was present during the incident. Medical record review for Resident 2 was initiated on 9/17/25. Resident 2 was admitted to the facility on [DATE]. Review of Resident 2's MDS assessment dated [DATE], showed Resident 2 had moderately impaired cognition. On 9/17/25 at 1600 hours, an observation and concurrent interview was conducted with Resident 2. Resident 2 was observed in her room lying on her bed. Resident 2 was asked if she witnessed any person slap or choke her roommate (Resident 1) or squeeze her roommate's hands. Resident 2 stated she had poor vision and had not seen anyone slap or choke Resident 1 or squeeze Resident 1's hands. Resident 2 stated she did hear Resident 1 yelling about being hit. On 9/17/25 at 1738 hours, an interview and concurrent facility document review was conducted with the Administrator. The Administrator stated he served as the facility's Abuse Coordinator. The Administrator stated the facility conducted an investigation specific to Resident 1's allegation that a facility staff member choked, slapped, and squeezed Resident 1's feet. The Administrator stated the SSD and Social Services Assistant (SSA) conducted interviews of the facility staff and residents during the course of the facility's investigation. The Administrator stated at the conclusion of the facility's investigation, the Residents Affected - Few (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: 555667 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 555667 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden Park Care Center 12681 Haster Street Garden Grove, CA 92840 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)