Health inspection·November 30, 2023

H &S § 1418.91 (a)A long-term health care facility shall report all incidents of alleged abuse or suspected abuse of a resident of the facility to the department immediately, or within 24 hours. (b)A failure to comply with the requirements of this section shall be a class “B” violation. 22 CCR § 72315 Nursing Service - Patient Care (b) Each patient shall be treated as individual with dignity and respect and shall not be subjected to verbal or physical abuse of any kind. 22CCR §72523 Patient Care Policies and Procedures (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. (b) All policies and procedures required of these regulations shall be in writing, made available upon request to physicians and other involved health professionals, patients or their representatives, employees and the public shall be carried out as written. 22 CCR § 72527 Patients' Rights. (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy of these policies available to the patient and to any representative of the patient. The policies shall be accessible to the public upon request. Patients shall have the right: (10) To be free from mental and physical abuse. 22CCR §72541 - Unusual Occurrences Occurrences such as epidemic outbreaks, poisonings, fires, major accidents, death from unnatural causes or other catastrophes and unusual occurrences which threaten the welfare, safety or health of patients, personnel or visitors shall be reported by the facility within 24 hours either by telephone (and confirmed in writing) or by telegraph to the local health officer and the Department. An incident report shall be retained on file by the facility for one year. The facility shall furnish such other pertinent information related to such occurrences as the local health officer or the Department may require. Every fire or explosion which occurs in or on the premises shall be reported within 24 hours to the local fire authority or in areas not having an organized fire service, to the State Fire Marshal. On 2/3/2023, the California Department of Public Health (CDPH) received a complaint regarding an allegation of a family member was observed hitting Resident 1 on the head and (right) hand in the shower room. On 2/7/2023, an unannounced visit was conducted at the facility. The facility failed to: 1. Report to the local health officer and the California Department of Public Health, within 24 hours, when family member was observed with signs of verbal abuse (a type of emotional abuse, that used a range of words or behaviors to manipulate, intimidate, and maintain power and control over a person. These include insults, humiliation and ridicule, the silent treatment, and attempts to scare, isolate, and control), yelling and verbally harsh to Resident 1. 2. Implement its policy and procedure (P&P) by failing to report an allegation of abuse for Resident 1 to the State survey Agency (SSA) within two hours after being made aware of the allegation. As a result of not reporting to DPH, there was a delay in the investigation by the State agency. A review of Resident 1’s admission record indicated Resident 1 was a 91-year-old female, was admitted to the facility on 10/04/2021, with diagnoses that included dementia (a condition characterized by progressive or persistent loss of intellectual functioning), Parkinson’s disease (a central nervous system disorder causing tremors), and depression (a mental health disorder characterized by a loss of interest in life). A review of Resident 1’s history and physician (H&P) dated 9/3/2022, indicated Resident 1 did not have the capacity to understand and make medical decisions. A review of Resident 1’s minimum data set ([MDS] a standardized care assessment and care screening tool), dated 7/22/2023, the MDS indicated Resident 1’s cognitive skills (thought process) was severely impaired. The MDS indicated Resident 1 was sometimes able to understand and be understood by others. The MDS indicated Resident 1 required extensive assistance with one to two persons assist with activities such as dressing, toilet use, personal hygiene, transfer (moving between surfaces to and from bed, chair, and wheelchair) and bed mobility (how resident moves from lying to turning side to side). The MDS indicated Resident 1 was always incontinent of bowel and bladder. A review of the facilities interdisciplinary team notes dated 2/6/2023 at 2 p.m., the notes indicated the reason for the meeting was the allegation of physical abuse investigation. The notes indicated that on 2/3/2023 at around 11:45 a.m., Resident 1 was brought to the shower room for the family member to color Resident 1’s hair. Resident 1 had attempted to touch or scratch her head while the hair was being colored by the family member while being assisted by CNA 1 and made the family member upset and screamed at Resident 1. Family member told CNA 1 to tie Resident 1’s hands down to the chair, but CNA 1 refused. During an interview on 11/29/23 at 9:43 a.m., LVN2 stated she was passing by the open shower room door and saw through the mirror the daughter was yelling at Resident 1 to stop scratching her head. LVN 2 further stated she saw the family member punch Resident 1 with a closed fist three times on top of her head. LVN 2 told the family member to stop hitting Resident 1 and then reported the incident to the Admin and DON. During an interview on 2/7/2023 at 2:24 p.m., CNA 2 stated she had observed Resident 1’s family member yell at Resident 1 and speak harshly. CNA 2 stated that she had heard Resident 1’s family member said, “Speak right, and stop talking like an old lady”. CNA 2 stated that she had not reported the yelling incident because this was not the first time the family member yelled at and spoke harshly (cruel) to Resident 1. CNA 2 stated the Administrator and DON were aware of Resident 1 family member’s verbal behavior towards the resident and staffs. During an interview on 2/7/2023 at 2:29 p.m., CNA 3 stated that she had observed Resident 1’s family member yelled at Resident 1 and said, “Speak right mom, and stop talking like an old lady”. CNA 3 stated that she had not reported her observations to the charge nurse or anyone. CNA 3 stated the Administrator and DON were aware of the verbal behavior of Resident 1’s family member because she had yelled and insulted them as well. During an interview on 2/7/2023 at 2:44 p.m., CNA 1 stated that Resident 1 had a constant itchy skin condition that made her scratch her body and head, Resident 1 would not stop scratching when the family starts dying her hair. The family member would then begin yelling at Resident 1, and the more Resident 1 would scratch herself. CNA 1 also stated that Resident 1 became more anxious as the family member continued to scream at her to stop scratching and “lift your head up!” CNA 1 stated that Resident 1’s family member asked her to tie Resident 1’s hands to the chair, however, CNA 1 explained she could not do that. CNA 1 also stated that Resident 1’s family member would yell at her for help to assist in pulling Resident 1 up while in the shower room when she sleds further down the chair. CNA 1 further stated that as she was walking back to the shower room to check on Resident 1, the LVN had told her to stay with Resident 1 as the family member was witnessed hit Resident 1 on the head. CNA 1 stated the family member should not yell at Resident 1as it made Resident 1 more anxious. During an interview on 2/7/2023 at 3:20 p.m., CNA 4 stated she had witnessed Resident 1’s family member yelled at Resident 1 and to all the staff as well. CNA 4 stated she did not agree with how the family member spoke to Resident 1 with her raised and harsh voice. CNA 4 stated she had not reported her findings to the charge nurse because most of the staff, including the DON and the administrator have also observed and heard Resident 1’s family member yelling at Resident 1. During an interview on 2/7/2023 at 4:00 p.m., the Administrator (Admin) stated he was aware of Resident 1’s family member’s yelling and speaking harshly to Resident 1, and to the staff, including himself. The admin stated they did not report the family member’s verbally abusive behavior against Resident 1 because the family member never used profanity or cursing words against Resident 1, only to staffs. The admin stated he never thought the family member would be capable of hitting Resident 1 like she did. A review of the facility’s undated CNA job description indicated, CNAs will report all accidents and incidents they observe on the shift that they occur. A review of the facility’s policies and procedures (P&P) titled, recognizing signs and symptoms of Abuse/ neglect, revised January 2011, indicated, our facility will not condone any form of resident abuse or neglect. To aid in abuse prevention, all personnel are to report any signs and symptoms of abuse/ neglect to the supervisor or to the Director of Nursing Services immediately. A review of the facility’s P&P titled “Abuse Prevention Program”, with a revision date of December 2016, the P&P indicated, the residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. This includes but is not limited to freedom from corporal punishment, involuntary seclusion, verbal, mental, sexual, or physical abuse, and physical or chemical restraint not required to treat the resident's symptoms. It also indicated, as part of the resident abuse prevention, the administration will identify and assess all possible incidents of abuse, investigate, and report any allegations of abuse within time frames as required by federal requirements. A review of the facility’s P&P titled, Resident Rights, revised December 2016, indicated the resident rights included the following: a. a dignified existence. b. be treated with respect, kindness, and dignity. c. be free from abuse, neglect, misappropriation of property, and exploitation. h. be supported by the facility in exercising his or her rights. The facility failed to: 1. Report to the local health officer and the California Department of Public Health, within 24 hours, when family member was observed with signs of verbal abuse (a type of emotional abuse, that used a range of words or behaviors to manipulate, intimidate, and maintain power and control over a person. These include insults, humiliation and ridicule, the silent treatment, and attempts to scare, isolate, and control), yelling and verbally harsh to Resident 1. 2. Implement its policy and procedure (P&P) by failing to report an allegation of abuse for Resident 1 to the State survey Agency (SSA) within two hours after being made aware of the allegation. As a result of not reporting to DPH, there was a delay in the investigation by the State agency. These violations had a direct or immediate relationship to the health, safety, security of Resident 1.