Inspection·October 15, 2024

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, facility document review, and facility P&P review, the facility failed to protect the resident's rights to be free from the verbal abuse by CNA 1 for one of two sampled residents (Resident 1) when CNA 1 yelled at Resident 1. Additionally, the facility staff failed to report the incident and intervene in the timely manner as per the facility's P&P. These failures had the potential to cause psychosocial harm to the residents. Findings: Review of the Facility's P&P titled Abuse, Neglect, Misappropriation and Exploitation dated 10/2022 showed the staff report any alleged violations involving verbal, sexual, physical, and mental abuse, corporal punishment, involuntary seclusion, and neglect of the resident as well as mistreatment, injuries of unknown source, and misappropriation immediately to the Senior Clinician, or Operational Leader, or District, or National Level and to other officials. Each resident is treated with dignity and respect and focuses on assisting the residents in maintaining, enhancing his or her self-esteem and self-worth and incorporates the residents' individuality as well as honor and value their input. Review of the facility's Investigation Report dated 10/7/24, showed the investigation of the incident between Resident 1 and CNA 1. The facility substantiated the allegation of verbal/emotional abuse. The report further showed a few staff members were able to confirm both the resident and accused CNA had a verbal exchange. Per the report, the CNA appeared to be frustrated due to the resident repeatedly pressing the call light after the CNA had explained to the resident that the social worker had been notified of Resident 1's request to speak with her and would come once she had a moment. CNA 1 was heard speaking to the resident in the elevated tone, this is why nobody visits you, this why your son doesn't like you, and this is why nobody likes you or visits you. The resident responded back, I hope you end up in a hospital with broken legs. The CNA responded with, I will pray for you and walked out of the door. Resident 1 slammed the door shut, and CNA 1 was heard repeating the same comments regarding Resident 1 in the hallway. Closed medical record review of Resident 1 was initiated on 10/14/24. Resident 1 was admitted to the facility on [DATE], and discharged on 10/4/24. On 10/14/24 at 1630 hours, a telephone interview was conducted with CNA 1. CNA 1 was asked about the incident with Resident 1. CNA 1 stated Resident 1 had been calling multiple times, asking for the social worker and inquiring about her discharge. CNA 1 stated she had informed the social worker and Resident 1 had to wait for the social worker. However, Resident 1 still pressed the call light. CNA (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 4 Event ID: 555859 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 555859 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Kindred Hospital Brea D/P Snf 875 N Brea Blvd Brea, CA 92821 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)