Inspection·December 23, 2024

F 0600 the capacity to understand and make decisions. Level of Harm - Actual harm A review of Resident 3's eINTERACT Change of Condition Form, indicated the following: Residents Affected - Few - On December 18, 2024, indicated, .At 0615H (6:15 a.m.), (Resident 3) approached (Resident 2) who was sitting on the chair across nursing station .(Resident 3) asked (Resident 2) about his missing item/thing .with angry voice .(Resident 2) ignored him and went towards his room .(Resident 3) get upset and punched the wall along the nurse station . - On December 18, 2024 at 10:55 a.m., indicated, .Physical aggression towards another resident (Resident 2) . A review of Resident 3's Progress Notes, dated December 18, 2024, indicated, .At around 10:55am at the hallway in front of the dining room, (Resident 3) was with activity director .(Resident 2) was walking towards the dining room .(Resident 3) suddenly swung his right hand towards (Resident 2) .(Resident 2) was hit on the right side of his face . A review of Resident 3's Care Plan, dated December 18, 2024, indicated, .Focus: Accused other resident of taking belongings and punched the wall .Interventions: Observe whether the behavior endangers .other resident .Intervene if necessary .removing others from the surrounding area. On December 23, 2024 at 10:12 a.m., during a concurrent interview and review of the progress notes for Residents' 2 and 3 with Registered Nurse (RN) 1, she stated on December 18, 2024, at 6:15 a.m., Resident 3 was agitated and accused Resident 2 of taking his belongings. RN 1 further stated Resident 3 became upset and punched a wall. RN 1 stated at 10:55 a.m. on December 18, 2024, (four hours after the allegation), Resident 3 was in the hallway in front of the dining room with the Activity Director (AD) when Resident 2 walked down the hallway toward them. RN 1 further stated when Resident 3 saw Resident 2, he swung his hand and hit Resident 2 on the right side of the face, causing a laceration. RN 1 stated activity and nursing staff were aware Residents 2 and 3 had an interaction at 6:15 a.m., and were instructed to keep the two residents apart at all times to prevent an altercation. RN 1 further stated staff should have redirected Resident 2 away from Resident 3 to avoid any interaction which could have prevented the incident. On December 23, 2024 at 10:55 a.m., during an interview with Resident 2, he stated on the morning of December 18, 2024, Resident 3 accused him of taking his belongings and became upset. Resident 2 further stated later that morning, at around 10 a.m., he was walking down the hallway in front of the dining room when Resident 3 suddenly punched him on the right side of the face, causing a laceration. On December 23, 2024 at 11:12 a.m., during an interview with the AD, she stated she was aware Residents 2 and 3 had an interaction on December 18, 2024 at 6:15 a.m., during which Resident 3 was agitated, accused Resident 2 of taking his belongings, and punched a wall. The AD further stated on December 18, 2024, at 10:55 a.m., she was with Resident 3 at the hallway outside the dining room when she saw Resident 2 walking down the hallway towards them. The AD stated she redirected Resident 3, but the resident refused. The AD further stated no facility staff redirected Resident 2 away from the hallway where Resident 3 was located. The AD stated when Resident 3 saw Resident 2, Resident 3 stood up and punched Resident 2 on the right side of the face, causing a laceration. On December 23, 2024 at 11:30 a.m., during an interview with the Director of Nursing (DON), she (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555740 If continuation sheet Page 2 of 3 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 555740 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Real Post Acute 1665 East Eighth Street Beaumont, CA 92223 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)

F 0600 Level of Harm - Actual harm Residents Affected - Few stated Residents 2 and 3 had an interaction on December 18, 2024 at 6:15 a.m., and activity and nursing staff were aware that both residents should be kept apart to prevent an altercation. The DON further stated Residents 2 and 3 had an altercation at 10:55 a.m. on December 18, 2024, in the hallway in front of the dining room, where Resident 3 punched Resident 2 on the right side of the face causing a laceration. The DON stated the altercation was preventable and the facility staff should have intervened, redirected, and removed Resident 2 from the hallway where Resident 3 was located, preventing the residents from seeing each other and avoiding the altercation. A review of the facility policy and procedure titled, Abuse, Neglect, Exploitation and Misappropriation Prevention Program, dated April 2021, indicated, .Residents have the right to be free from abuse .This includes but is not limited to freedom from .Physical abuse .by anyone including .Other residents . A review of the facility policy and procedure titled, Resident-to-Resident Abuse, undated, indicated, .If a resident-to-resident incident occurs, staff should immediately intervene .Separate the residents and take them to areas away from each other until the situation subsided . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555740 If continuation sheet Page 3 of 3