Health inspection·March 13, 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to report an allegation of abuse to the California Department of Public Health (CDPH), within two hours, when one out of three residents, Resident 1, alleged a Registered Nurse (RN) hit her on the right side of the face on 3/1/2025. This deficient practice had the potential to place Resident 1 at risk for further abuse and resulted in a delay in investigation of alleged abuse. Findings: During a review of Resident 1 ' s admission Record, the admission Record indicated Resident 1 was admitted to the facility on [DATE]. Resident 1 ' s diagnoses included muscle weakness and anxiety disorder (mental health condition characterized by excessive, persistent, and often irrational worry, fear, and unease that can interfere with daily life). During a review of Resident 1 ' s History and Physical (H&P) dated 2/19/2025, the H&P indicated Resident 1 did not have the capacity to understand and make decisions. During a review of Resident 1 ' s admission Reassessment document dated 2/19/2025, the reassessment indicated Resident 1 had a puffy face and the peri-orbital (around eyes) area. During a review of Resident 1 ' s Minimum Data Set ([MDS] a federally mandated resident assessment tool) dated 2/24/2025, the MDS indicated Resident could sometimes make herself understood and was understood by others. The MDS indicated Resident 1 was dependent for oral hygiene, toileting hygiene, shower/bath, dressing, putting on/taking off footwear and for personal hygiene. During an interview on 3/13/2025 at 12:27 p.m., with Family Member 2 (FM 2), FM 2 stated on 3/1/2025 around 2 p.m., when FM 2 visited Resident 1, RN entered the room and Resident 1 covered her face. FM 2 stated Resident 1 told FM 2 the RN hit her (Resident 1). FM2 stated the RN told her (FM 2) that Resident 1 was confused and hitting Resident 1 did not happen. During an observation and interview on 3/13/2025 at 1:00 p.m., with Resident 1, Resident 1 had a puffy periorbital area of both eyes (as also indicated in the reassessment dated [DATE]), no swelling or bruising observed. Resident 1 had dark skin discoloration on the face. Resident 1 stated RN hit her on the face, pointing to her right eye and could not remember the date it happened. Resident 1 stated RN was handling her g-tube (gastrostomy tube, a tube surgically inserted through the abdomen into the stomach, used to deliver food, liquids, and medications) when RN hit her. Resident 1 stated (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: 555719 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 555719 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Imperial Crest Health Care Center 11834 Inglewood Avenue Hawthorne, CA 90250 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)