Inspection·December 16, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. Based on observations, interviews and record reviews, the facility failed to ensure an abuse allegation between Residents 1 and 2 was reported to the state licensing/certification agency (the state) within 2 hours. This failure could put the residents at significant risk for continued harm, which could lead to severe physical and psychological trauma.Findings:A review of Resident 1's face Sheet (front page of the chart that contains a summary of basic information about the resident) indicated an admission date in 12/2017 with a diagnosis of Schizophrenia (a mental illness that is characterized by disturbances in thought) and major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest).A review of Resident 1's Brief Interview for Mental Status (BIMS, an assessment tool used by facilities to screen and identify memory, orientation, and judgement status of the resident), dated 6/27/25, score was 10 indicating Resident 1 had moderately impaired thinking and memory.A review of Resident 2's face sheet indicated an admission date in 9/2023 with a diagnosis of Dementia (a progressive state of decline in mental abilities) and Major Depressive disorder. A review of Resident 2s BIMS, dated 6/18/25, score was 10 indicating Resident 2 had moderately impaired thinking and memory.A review of the SOC 341 form (written report used by mandated reporters when abuse or neglect of an elder (65+) or dependent adult (18-64 with disabilities) is suspected), dated 7/31/25, indicated, .at around 5:10 AM. Resident states that he does not know why roommate hit him.and roommate just punched him in the face.resident hit roommate on the right temple.roommate retaliated by hitting resident back on the nose. The fax confirmation sheet indicated the SOC 341 form was sent to the state licensing/certification agency on 7/31/25 at 8:50 a.m.During an interview on 8/20/25 at 2:14 p.m., the Minimum Data Set coordinator (MDSC) stated abuse allegations should be reported to the state within 2 hours of discovery. MDSC stated if the abuse allegation was not reported to the state within 2 hours, residents' safety could be at risk.During an interview on 8/20/25 at 3:27 p.m., the Director of Staff Development (DSD) stated that abuse allegations should be reported to the state within 2 hours of discovery. The DSD stated if not reported to the state immediately, within 2 hours, resident could be at risk for continued abuse.During a concurrent interview and record review on 12/16/25 at 11:41 a.m., with the Director of Nursing (DON), the SOC 341, sent to the state on 7/31/25 at 8:50 a.m., was reviewed. The DON verified the facility was aware of the abuse allegation on 7/31/25 at 5:10 a.m. The DON stated that abuse allegations should be reported to the state within 2 hours of discovery. The DON verified that this abuse allegation was reported late to the state. A review of the facility's policy and procedure (P&P) titled Abuse, Neglect, Exploitation, or Misappropriation-Reporting and Investigating, revised 9/2022, the P&P indicated, .the administrator or the individual making the allegation immediately reports his or her suspicions to the following persons or agencies: state licensing/certification agency responsible for surveying/licensing the facility, local state ombudsman, law enforcement official.immediately is defined as within 2 hours of an allegation involving abuse or result in serious bodily injury. 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: 555703 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 555703 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgeway Post Acute 523 Hayes Lane Petaluma, CA 94952 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)