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Complaint Investigation

Horizon Health & Subacute Center

Inspection Date: July 9, 2024
Total Violations 1
Facility ID 055199
Location FRESNO, CA

Inspection Findings

F-Tag F600

Harm Level: Minimal harm or
Residents Affected: Few Based on interview and record review, the facility failed to report the findings of an investigation of an abuse

F-F600].

Findings:

During a review of the document titled SOC341 - Report of Suspected Dependent Adult/Elder Abuse (submitted to the Department from the facility), dated 6/24/24, the SOC341 indicated that on that date between 5 PM and 5:15 PM, Resident 1 was observed in his bathroom yelling. [Mental Health Worker, or MHW] attempted to de-escalate the patient. Resident [1] then pushed [MHW. MHW] responded by pushing patient with two hands on each shoulder causing resident to stumble back.

During an interview on 7/9/24, at 4:30 PM, with the Administrator, the Administrator stated, We don't have a 5-day follow up report.

During a review of the facility's policy and procedure (P&P) titled, Reporting of Alleged Violations, dated 3/18,

the P&P indicated, A completed copy of all investigation findings, documentation forms and written statements from witnesses, for all allegations of abuse, must be provided to the Administrator/designee; and to other officials in accordance with State law, including to the State Survey Agency, within 5 working days of

the incident, and if the alleged violation is verified appropriate corrective action must be taken.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 5 of 5 055199

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