Health inspection·August 15, 2024

F 0610 Respond appropriately to all alleged violations. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to conduct a thorough investigation and report for nine of 11 residents (Residents 7, 8, 9, 10, 11, 12, 1, 3, and 4). Residents Affected - Some This failure had the potential to compromise the facility's ability to determine the circumstances surrounding the incidents and could have compromised the residents' safety. Findings: During a review of the 5-day investigation summary of an alleged altercation between Residents 7 and 8, the summary did not indicate the outcome for the facility's investigation of whether the facility was able to determine if they thought the altercation did occur, or not. During a review of the 5-day investigation summary of an alleged altercation between Residents 9 and 10, the summary did not indicate the outcome for the facility's investigation of whether the facility was able to determine if they thought the altercation did occur, or not. During a review of the 5-day investigation summary of an alleged altercation between Residents 11 and 12, the summary did not indicate the outcome for the facility's investigation of whether the facility was able to determine if they thought the altercation did occur, or not. During a review of the 5-day investigation summary of an alleged altercation between Residents 1 and 10, the summary did not indicate the outcome for the facility's investigation of whether the facility was able to determine if they thought the altercation did occur, or not. During a concurrent interview and record review on 6/20/24 at 2:20 p.m., with the Administrator (ADM), the ADM reviewed the facility's 5-day investigation summary and confirmed that the reports does not have a conclusion of the investigation. A review of the facility submitted document SOC 341 (Report of Suspected Dependent Adult/Elder Abuse), dated 5/25/23, indicated an alleged altercation occurred between Residents 3 and 4 on 5/25/23. A review of the facility's 5-day investigation summary sent to the Department, indicated a resident [Resident 14] was with Resident 3 and 4 at the time of the alleged altercation and no documentation that the resident [Resident 14] was interviewed. During an interview on 8/15/24 at 12:21 p.m., with the Case Manager (CM), the CM confirmed that Resident 14 was with Resident 3 and 4 during the alleged altercation. The CM stated she interviewed Resident 14 about the incident but did not document. The CM stated witnesses must be interviewed in an Page 1 of 2 555792 555792 08/15/2024 Sunnyvale Post-Acute Center 1291 S Bernardo Avenue Sunnyvale, CA 94087

F 0610 alleged altercation and documented. Level of Harm - Minimal harm or potential for actual harm Review of the facility's policy and procedure titled, Abuse, Neglect, Exploitation or Misappropriation Reporting and Investigating, dated 9/22, indicated Investigating allegations .6. The individual conducting the investigation may include .e. interviews any witnesses to the incident. Follow-up report .2. The follow-up investigation report will provide sufficient information to describe the results of the investigation, and indicate any corrective actions taken if the allegation was verified. Residents Affected - Some 555792 Page 2 of 2