Health inspection·January 19, 2024

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many 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 observation, interview, and record review, the facility failed to report one incident of resident abuse to authorities within the required two-hour time frame after the allegation was made. This failure to report an allegation of abuse within the Federally mandated requirement of two hours, had the potential to result in ongoing resident abuse and physical, mental, and /or emotional harm, and prevented the State Agency from conducting a timely investigation into the allegation. Findings: During a review of a report titled State of California Report of Suspected Dependent/Elder Abuse (SOC 341) dated 1/1/24, the SOC 341 indicated alleged abuse occurred on 12/30/23 with exact time unknown. The SOC 341 indicated telephone report made to the State Agency and Local Ombudsman on 12/31/23 at 12:15 p.m. and written report was faxed 1/1/24 at 10:49 a.m. During a review of a document titled SOC 341 General Instructions, dated 8/22, Instructions indicated, If the abuse occurred in a Long-Term Care (LTC) facility, was physical abuse, but did not result in serious bodily injury .send the written report to the local law enforcement agency, the local Long term Care Ombudsman Program (LTCOP), and the appropriate licensing agency within 24 hours of observing, obtaining knowledge of, or suspecting physical abuse. During a review of a document titled Abuse Allegation Follow-Up Report, dated 1/3/24, the Follow-Up Report indicated, On Sunday, December 31st, verbally reported this allegation to CDPH, and the local Ombudsman, and faxed the SOC 341 on Monday, January 1st, 2024. During an interview on 1/10/24 at 9:00 a.m., the Director of Nursing (DON) stated abuse incident occurred when alleged perpetrator (contracted vendor staff) sitter (a non-licensed staff hired to provide companionship and did not provide direct patient care) allegedly hit Resident 1 (R1). DON stated the alleged victim, R1, had a 1:1 sitter for safety reasons due to impulsivity and throwing things. The DON stated the alleged perpetrator no longer worked at the facility. The DON stated the Certified Nursing Assistant A (CNA A) reported the alleged abuse to the Director of Staff Development (DSD) on 12/31/23. During an interview on 1/10/24 at 9:45 a.m., the Administrator stated verbal report of abuse was made to the California Department of Public Health (CDPH) and the Ombudsman on 12/31/23. The Administrator was unable to provide time or documentation of verbal reporting. Page 1 of 2 555836 555836 01/19/2024 Arbol Healthcare Center of Santa Rosa 300 Fountaingrove Parkway Santa Rosa, CA 95403

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During the same interview on 1/10/24 at 9:45 a.m., the Administrator stated Abuse and Neglect training was completed upon hire, annually, and as needed. The Administrator trained all staff on December 5, 2023, on abuse, including reporting and the State of California form Report of Suspected Dependent/Elder Abuse (SOC 341). Administrator stated if abuse did not result in bodily injury reporting was within 24 hours and if it did result in bodily injury, we reported within two hours and followed up with a written report. The Administrator stated the outcome of the abuse investigation was unsubstantiated. (Unsubstantiated does not mean it did not happen, it means there was not enough evidence to prove it happened.) During an interview on 1/10/24 at 10:10 a.m., the DSD stated CNA A called her at home on [DATE] to report allegation of abuse had occurred on 12/30/23. During an interview on 1/10/24 at 10:15 a.m., the DSD stated, we reported to the Administrator and the DON as soon as we were aware. The DSD stated reporting times were, I think 36 hours, two days. DSD stated she got information about alleged abuse over the phone from CNA A on 12/31/23. DSD stated she called the facility, the DON, the Administrator, the contracted vendor which employed the alleged perpetrator, and left voice messages for the State Agency and the Ombudsman. During a review of a document titled Written Statement from LN A, dated 1/9/24, statement indicated, CNA A verbally reported alleged abuse to her on 12/30/23 at around 1100 a.m. LN A further stated, I did not do incident reporting as CNA A called the DSD and reported this claim to her the following morning. Document further stated, I will make a report ASAP if witnessed abuse happened, reporting right away within 4-6 hours and papers documentation filed within 24-48 hours to local authorities. During a review of a document titled Elder Justice Act Notice to Employees, dated 11/07/11, Notice indicated, Reports of the reasonable suspicion of a crime against a resident of the Health Center must be made to the California Department of Public Health and local law enforcement entity within 2 hours if there is serious bodily injury. If events causing the suspicion do not result in serious bodily injury, it must be reported within 24 hours after forming the suspicion. This document is included in the current Facility Orientation and Abuse Packet. During a review of a document titled Arbol Residences of Santa [NAME] Abuse Prevention Policy, dated 05/07/12, indicated, If a resident sustains a serious bodily injury the law enforcement agency and the California Department of Health (707-576-6775) must be contacted within two hours of forming the suspicion. If the resident ' s injury is not serious, the law enforcement agency and the California Department of Public Health must be contacted within 24 hours after forming the suspicion. This document is included in the current Facility Orientation and Abuse Packet. 555836 Page 2 of 2