Health inspection·February 7, 2025

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 and record review, the facility failed to protect one of one residents (Resident 1) from sexual abuse when a Certified Nursing Assistant (CNA1) engaged in a consensual sexual act with a resident. This failure placed Resident 1 at risk for emotional distress, psychological trauma, mistrust of health care providers, and disruption in the patient's ability to receive proper medical care. Findings: On 1/14/25, the California Department of Public Health (CDPH) received a facility reported incident from the facility to report an incident in which CNA 1 had sexual relations with Resident 1 inside his bedroom. On 1/24/25 at 9:30 A.M. an on-site visit was conducted by CDPH to investigate the incident. According to the admission Record, Resident 1 was admitted to the facility on [DATE] with diagnoses which included bipolar disorder (a mental illness that causes extreme shifts in moods) , post-traumatic stress disorder ( a condition in which a person has difficulty recovering after experiencing or witnessing a terrifying event), schizoaffective disorder (a disorder that includes symptoms such as hallucinations, delusions with mood disorder symptoms). A review of Resident 1's Electronic Health Record indicated Resident 1 was placed under conservatorship (a legal status in which a court appoints a person to assume guardianship over an adult) on 7/8/24. According to the History and Physical dated 8/9/24, [Resident 1] does not have capacity to make medical decisions . A review of the Minimum Data Set (MDS, an assessment tool) dated 11/13/24 indicated Resident 1 was cognitively intact with a BIMS (a tool to measure cognition) score of 14. On 1/24/25 at 9:44 A.M. an interview was conducted with Resident 1. Resident 1 stated he met CNA 1 after he was admitted to the facility. Resident 1 stated, .after a couple weeks we developed a friendship. We talked about books . Resident 1 stated CNA 1 visited him at the facility on days when she was not scheduled to work. In addition, Resident 1 stated CNA 1 gifted him with three books and wrote messages for him on the inside cover of the books. Resident 1 stated he had asked her to perform a sexual act on him and .we were like friends with benefits. (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: 555887 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 555887 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/07/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lakeside Special Care Center 11962 Woodside Avenue Lakeside, CA 92040 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)