Other·December 13, 2017

F000 INITIAL COMMENTS

F000 DEFICIENCY) COMPLETE DATE The following reflects the findings of the Department of Public Health during an Entity Reported Incident (ERI) investigation during an Abbreviated Standard Survey. ERI Intake Number: CA00549930 Substantiated, with regulatory violations Representing the Department of Public Health: Evaluator ID Number: 34559, RN, HFEN Inspection was limited to the specific ERI investigated and does not represent the findings of a full inspection of the facility. One deficiency was issued for ERI Number CA00549930.

F226 SS=D DEVELOP/IMPLMENT ABUSE/NEGLECT, ETC POLICIES CFR(s): 483.12(b)(1)-(3), 483.95(c)(1)-(3)

F226 11/22/2017 483.12 (b) The facility must develop and implement written policies and procedures that: (1) Prohibit and prevent abuse, neglect, and exploitation of residents and misappropriation of resident property, 555805 11/15/2017 BEL VISTA HEALTHCARE CENTER 5001 E Anaheim St Long Beach, CA 90804 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE (2) Establish policies and procedures to investigate any such allegations, and (3) Include training as required at paragraph §483.95, 483.95 (c) Abuse, neglect, and exploitation. In addition to the freedom from abuse, neglect, and exploitation requirements in § 483.12, facilities must also provide training to their staff that at a minimum educates staff on(c)(1) Activities that constitute abuse, neglect, exploitation, and misappropriation of resident property as set forth at § 483.12. (c)(2) Procedures for reporting incidents of abuse, neglect, exploitation, or the misappropriation of resident property (c)(3) Dementia management and resident abuse prevention. This REQUIREMENT is not met as evidenced by: Based on interview and record review, the facility failed to implement their abuse policy and procedure to protect one of two sampled residents (Resident 1) after an allegation of abuse, by not reporting the incident immediately after it occurred. This deficient practice placed Resident 1 at risk for harm and exposure to the alleged perpetrator and had the potential to place other residents at risk for harm. Findings: 555805 11/15/2017 BEL VISTA HEALTHCARE CENTER 5001 E Anaheim St Long Beach, CA 90804 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE A review of Resident 1's Admission Record indicated the resident was admitted to the facility on 7/11/17. Resident 1's diagnosis included dementia (a group of thinking and social symptoms interfering with daily functioning), major depression (a mental health disorder characterized by persistently depressed mood or loss of interest in activities), anxiety disorder (a mental health disorder characterized by feelings of worry or fear strong enough to interfere with one's daily activities), and generalized muscle weakness. A review of Resident 1's Minimum Data Set (MDS), a resident assessment and carescreening tool, dated 7/20/17, indicated Resident 1's cognition (ability to think and reason) was severely impaired. The MDS indicated Resident 1 required extensive oneperson physical assistance for all activities of daily living (ADLs). During an interview, on 9/5/17, at 1:10 p.m., the Administrator stated during a resident council meeting, Resident 1's Roommate (Resident 2) informed the Activity Director (AD) that Resident 1's private caregiver slapped her during the night shift. The Administrator stated Resident 2 told her, she heard the slap, but the curtain was closed. The Administrator stated no one from the evening/night shift reported the incident to her. During a telephone interview, on 9/5/17, at 1:45 p.m., CNA 2 indicated she saw Resident 1's Caregiver (CG 1) push Resident 1's head as she walked past her bed. When asked what she did, CNA 2 stated she told the Assistant Administrator about the incident when she returned back to work the following day. CNA 2 stated the incident happened on her first day of work from being off and could not believe what she saw. CNA 2 further stated any 555805 11/15/2017 BEL VISTA HEALTHCARE CENTER 5001 E Anaheim St Long Beach, CA 90804 PREFIX TAG ID PREFIX TAG DEFICIENCY) COMPLETE DATE incidents of abuse should be reported immediately. A review of CNA 1's Written Statement, dated and signed on 8/24/17, indicated CNA 1 saw CG 1 pushing Resident 1's head back. A review of CNA 2's Written Statement, dated and signed on 8/25/17, indicated CNA 2 saw CG 1 roughly pushing Resident 1's head back on the bed to make her lay down. A review of the Assistant Administrator's Written Statement, dated 8/26/17, indicated CG 1 stated she may have "accidentally" hit Resident 1 while slapping her hands away from her to prevent Resident 1 from biting her. A review of the facility's policy and procedures titled, "Preventing Resident Abuse", dated 8/11, indicated the facility encouraged all personnel, residents, family members, visitors, etc., to report any signs or suspected incidents of abuse to facility management immediately.