Health inspection·June 14, 2024

§483.12 Freedom from Abuse, Neglect, and Exploitation The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart. This includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident’s medical symptoms. §483.12(a) The facility must— §483.12(a)(1) Not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion; 22 CCR §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. § 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: . . . (8) To be free from discrimination based on sex, race, color, religion, ancestry, national origin, sexual orientation, disability, medical condition, marital status, or registered domestic partner status. On 5/1/2024, the California Department of Public Health (CDPH) made an unannounced visit at the facility to investigate a facility reported incident regarding an allegation of abuse. The facility failed to ensure Resident 1, who had a history of dementia (impaired ability to remember, think, or make decisions that interferes with doing everyday activities), was free from physical abuse. On 4/21/2024 at 8:20 a.m., Resident 1 reported to the Restorative Nursing Assistant 1 (RNA 1) that Resident 2, a roommate, threw a cup at Resident 1's face. As a result, on 4/21/2024, Resident 1 sustained a right cheek skin tear measured 1.0 centimeter ([cm] a unit of measurement) long and 1.0 cm wide, with bleeding, pain, swelling, and blurred vision. On 4/22/2024, Resident 1 was transferred to a General Acute Care Hospital 1 (GACH 1) for evaluation and further management of right upper cheek swelling and increasing pain. A review of Resident 1’s Admission Record indicated the 79-year-old male resident was admitted to the facility on 2/5/2018 with diagnoses including chronic obstructive pulmonary disease ([COPD] disease that cause airflow blockage and breathing-related problems), dementia and difficulty in walking. A review of Resident 1's Minimum Data Set ([MDS] a standardized assessment and care-screening tool), dated 2/1/2024, indicated Resident 1 required a moderate assistance from staff for toileting, personal hygiene, and transfers. The MDS indicated Resident 1 used a wheelchair for mobility. A review of Resident 1's History and Physical (H&P), dated 3/30/2024, H&P indicated the resident did not have the capacity to understand and make decisions. A review of Resident 1's Change of Condition ([COC]-a significant change in a member's health or functional status that will not normally resolve itself without further intervention), dated 4/21/2024, indicated there was a resident-to-resident altercation. The COC indicated Resident 1 had swelling, abrasion (a superficial rub or wearing off the skin, usually caused by a scrape or a brush burn), and bleeding to the right side of the face. A review of Resident 1's Weekly Skin/Wound Assessment, dated 4/21/2024, the Weekly Skin/Wound Assessment indicated Resident 1 had the right cheek bone skin tear measured 1.0 cm long and 1.0 cm wide, and the right eye periorbital (around the eye) swelling. A review of Resident 1's Progress Notes, dated 4/21/2024, indicated on 4/21/2024 at 8:20 a.m., Restorative Nursing Assistant 1 (RNA 1) notified Licensed Vocational Nurse 1 (LVN 1) that Resident 1 had an altercation with Resident 2. The Progress Note indicated Resident 2 threw a cup at Resident 1's face on 4/21/2024 at 7 a.m. A review of Resident 1's Progress Note, dated 4/22/2024, indicated Resident 1 was transferred to GACH 1 for evaluation and management of right upper cheek swelling and pain. A review of Resident 1's Ophthalmology (medical science of eye diseases) Exam/ Consult and Report, dated 4/24/2024, indicated Resident 1 had evaluation of the right eye vision due to redness. The Ophthalmology Exam/ Consult and Report indicated Resident 1 had ecchymosis (a small bruise caused by blood leaking from broken blood vessels into the tissues of the skin or mucous membranes) and contusion (an injury that causes bleeding and tissue damage underneath the skin, usually without breaking the skin) to the orbit (cavity or socket/hole of the skull in which the eye is situated) of the right eye. A review of Resident 2's Admission Record, the Admission Record indicated the 40-year old male resident was admitted to the facility on 3/27/2024 with diagnoses including hemiplegia (complete paralysis) and hemiparesis (partial weakness) following cerebral infarction (occurs as a result of disrupted blood flow to the brain due to problems with the blood vessels that supply it) affecting left non dominant side, hypertension (high blood pressure) and schizophrenia (a serious mental illness that affects how a person thinks, feels, and behaves). A review of Resident 2's H&P, dated 3/30/2024, indicated the resident had capacity to understand and make decisions. A review of Resident 2's MDS, dated 4/3/2024, indicated the resident had an intact cognition. A review of Resident 2's COC dated 4/21/2024, indicated there was a resident-to-resident altercation. The COC indicated Resident 2 threw a cup at Resident 1. A review of Resident 2's Interdisciplinary ([IDT]-a coordinated group of experts from several different fields who work together) team Care Conference Notes, dated 4/22/2024, indicated Resident 1 made racial slur comments and threw a cup at Resident 2 first and Resident 2 responded by throwing the cup back at Resident 1. The IDT team Care Conference notes indicated Resident 2 was on Seroquel (medication used to treat schizophrenia) for schizophrenia manifested by auditory hallucinations (when you hear voices or noises that aren't there) as evidenced by hearing his name repeatedly. During a concurrent observation and interview on 5/1/2024 at 8:55 a.m., with Resident 1 inside his room, Resident 1 was observed lying in bed with two pillows under his head and covered with white sheet from waist down. Resident 1 was observed to have a black scab (a dry, rough protective crust that forms over a cut or wound during healing) on the right cheek. Resident 1 stated Resident 2 threw a hard plastic cup at him resulting in skin cut and pain on his right side of the face. Resident 1 stated his pain was eight out of ten on a pain scale (a tool use to help assess a person's pain) from zero to ten where zero is no pain and 10 is the worse pain possible. Resident 1 stated he had blood all over his face. Resident 1 stated the doctor did not come to see him and he was sent to the hospital where he had an x-ray (an imaging test to view internal body structure) two days after he was hit. Resident 1 stated he did not have any vision problem before the incident but now his vision is blurry, and he cannot see well. During an interview on 5/1/2024 at 9:08 a.m., Resident 2 stated Resident 1 was making racial slur comments at him. Resident 2 stated Resident 1 threw the cup initially at him, so he threw it back. Resident 2 stated the cup thrown by Resident 1 did not hit him. During an interview on 5/1/2024 at 9:12 a.m., RNA 1 stated on 4/21/24 at 8:20 a.m., he went inside Resident 1 and Resident 2's room and saw Resident 1 lying in bed with blood on his right side of the face. RNA 1 stated that Resident 2 was on his bed. RNA 1 stated Resident 1 reported, while pointing at Resident 2's direction, that Resident 2 hit him with a cup. RNA 1 stated Resident 2 replied that Resident 1 was making racial slur comments. RNA 1 stated he called LVN 1 who was walking in the hallway. RNA 1 stated when LVN 1 came inside the room, RNA 1 went out and called Registered Nurse 1 (RN 1) and Treatment Nurse 1 (TN 1). During an interview on 5/1/2024 at 9:22 a.m., LVN 1 stated on 4/21/2024, RNA 1 notified her that Resident 1 and Resident 2 had an altercation. LVN 1 stated when she went inside the residents' room she saw Resident 1's right side of the face with blood, bruise, and a bump. LVN 1 stated Resident 2 reported that Resident 1's television was loud, and he asked Resident 1 to turn the volume down, but Resident 1 responded by making racial slur comments. LVN 1 stated Resident 2 admitted throwing the cup back at Resident 1 after Resident 1 threw it at him first. During a concurrent interview and record review on 5/1/2024 at 9:40 a.m., TN 1, Resident 1's Weekly Skin/Wound Assessment, dated 4/21/2024, was reviewed. The Weekly Skin/ Wound Assessment indicated Resident 1 had a right cheek skin tear measured 1.0 cm long by 1.0 cm wide and the right periorbital eye swelling. TN 1 stated on 4/21/2024, LVN 1 notified him of Resident 1 and Resident 2 altercation. TN 1 stated when he went inside the residents' room, he saw Resident 1 with blood coming down from his right cheek and his (Resident 1) face looked swollen. During an interview on 5/3/2024 at 8:49 a.m., the Director of Staff Development (DSD) stated abuse is the unintentional hurting of someone. The DSD stated the incident between Resident 1 and Resident 2 was not an abuse because Resident 2 had the intention to throw the cup back at Resident 1. The DSD stated that was her understanding about abuse incidents. During an interview on 5/3/2024 at 9:18 a.m., the Director of Nursing (DON) stated Resident 2 informed her that it was self-defense because Resident 1 was insulting him, and he got frustrated. The DON stated Resident 2 did not deny throwing the cup at Resident 1. The DON stated abuse is deliberate infliction of injury and altercation falls under abuse. During an interview on 5/3/2024 at 9:34 a.m., the Administrator (ADM) stated Resident 2 abused Resident 1. The ADM stated both residents denied, however, there was evidence that something took place because there was injury to Resident 1 and that was abuse. A review of facility's policy and procedure (P&P) titled, "Abuse-Prevention, Screening, and Training Program." dated 7/2018 and reviewed on 3/26/2024, indicated, abuse is defined as the willful, deliberate infliction of injury, unreasonable confinement, involuntary seclusion, physical or chemical restraint not required to treat symptoms and or imposed for the purposes of discipline or convenience, intimidation, exploitation, misappropriation of resident property, mistreatment, and injuries of unknown source or punishment with resulting physical harm, pain, ,mental anguish ...It includes verbal abuse, sexual abuse, physical abuse, mental abuse or abuse facilitated or enabled by the use of technology that cause physical harm, pain or mental anguish. Physical abuse is defined as, but not limited to, hitting, slapping, punching, and or kicking. Mental Abuse, emotional abuse and psychological abuse are defined as, but is not limited to, verbal or nonverbal conduct that causes humiliation, intimidation, fear, shame, agitation, or degradation. A review of facility's P&P titled, "Reporting Abuse," dated 1/8/2014 and reviewed on 3/26/2024, indicated the facility will ensure that the resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion. The facility failed to ensure Resident 1, who had a history of dementia, was free from physical abuse. On 4/21/2024 at 8:20 a.m., Resident 1 reported to the RNA 1 that Resident 2, a roommate, threw a cup at Resident 1's face. As a result, on 4/21/2024, Resident 1 sustained a right cheek skin tear measured 1.0 cm long and 1.0 cm wide, with bleeding, pain, swelling, and blurred vision. On 4/22/2024, Resident 1 was transferred to a GACH 1 for evaluation and further management of right upper cheek swelling and increasing pain. The above violations jointly, separately, or in any combination, presented either imminent danger that death or serious harm would result or a substantial probability that death or serious physical harm would result to Resident 1.