Skyline Healthcare Center - La

During an interview on 4/1/2025 at 2:14 p.m. with Resident 1, Resident 1 stated the incident with

Resident 1 stated it (Resident 2 scratching her right lower foot) shook her and made her (Resident 1) scared.

During an interview on 4/1/2025 at 2:23 p.m. with CNA 1, CNA 1 stated she worked on 3/20/2025 from 11 p.m. to 7 a.m. and was assigned to care for Residents 1 and 2. CNA 1 stated on 3/21/2025 at around 6:45 a.m., Resident 2 sat up in Resident 2 ' s bed upset and began to shout and yell at the Housekeeper (HK) 1 who was cleaning Resident 1 and Resident 2 ' s room. CNA 1 stated Resident 2 stood up wanting to walk, grabbed the detachable remote control of the bed, and began to swing the bed remote control at CNA 1. CNA 1 stated Licensed Vocational Nurse (LVN) 2 and LVN 3 came to Resident 2 ' s room. CNA 1 stated Resident 2 had the bed remote control in Resident 2 ' s left hand and was walking towards the door. CNA 1 stated CNA and the LVNs (LVNs 2 and 3) were walking around Resident 2 to support Resident 2 from falling but also avoiding getting hit by Resident 2. CNA 1 stated CNA 1 saw Resident 2 walked all the way to Resident 1 ' s bed (nearest the door) and scratched Resident 1 ' s foot (right lower foot). CNA 1 stated Resident 1 said, She (Resident 2) scratched my foot.

During a concurrent interview and record review on 4/1/2025 at 3:57 p.m., the facility-provided Transmission Verification Report (a document that verifies the successful transmission of a fax), dated 10/1/2013 at 9:15 p.m., was reviewed with the DON.

The DON stated the Transmission Verification Report ' s date of 10/1/2013 at 9:15 p.m. was incorrect.

The DON stated this was regarding a resident to resident abuse (Resident 1 and Resident 2) which she (DON) sent to the SSA on 3/21/2025 at around 11:40 a.m. the DON stated Resident 2 scratched Resident 1 ' s right lower foot on 3/21/2025 at around 7 a.m. to 7:30 a.m.

The DON stated she saw Resident 1 on 3/21/2025 at around 9 a.m. in the hallway and Resident 1 told her (DON) Resident 2 scratched Resident 1 ' s right lower foot.

The DON stated Resident 2 scratching Resident 1 ' s right lower foot is considered physical abuse.

The DON stated the facility does not allow abuse because Resident 1 can psychosocially (refers to how both the psychological [relating to the mental and emotional state] and social factors contribute to a person ' s overall well-being, development, and functioning) feel unsafe in Resident 1 ' s environment and the potential for further harm.

The DON stated knowledge or suspicion of physical abuse must be reported within two hours.

The DON stated her staff should have reported to the Administrator and/or the DON and should have reported the incident immediately.

The DON stated staff knew about the incident around 7:45 a.m. and it was reported around 11:30 a.m. (by the DON) to the SSA indicated a delay in the reporting.

The DON stated the potential for not reporting within the two-hour timeframe can place the residents at further risk for abuse.

During a review of the facility ' s P&P titled, Reporting Abuse, last reviewed on 4/4/2024, the P&P indicated, The facility will report known or suspected instances of physical abuse to the proper authorities by telephone or through a confidential internet reporting tool as required by state and federal regulations. I. If the reportable event results in serious bodily injury, a telephone report shall be made to the local law enforcement agency immediately and no later than two (2) hours) of the observation, knowledge or suspicion of the physical abuse. In addition, a written report shall be made to . the California Department of Public Health (or SSA) . within two (2) hours of the observation, knowledge, or suspicion of the physical abuse.

During a review of Resident 1 ' s Admission Record (AR), the AR indicated the facility admitted Resident 1 on 2/12/2025 with diagnoses including parkinsonism (a broad term that refers to brain conditions that caused slowed movements, rigidity [stiffness], and tremors), quadriplegia (a severe medical condition characterized by the partial or total loss of function in all four limbs [arms and legs] and the torso [the main part of the body that contains the chest, abdomen, pelvis, and back), and depression (a persistent state of sadness and loss of interest that can significantly affect how you feel, think, and behave, making it hard to enjoy life or carry out daily activities).

During a review of Resident 1 ' s Minimum Data Set (MDS - a resident assessment tool) dated 2/16/2025, the MDS indicated Resident 1 had intact cognition (refers to the mental processes involved in knowing, learning, and understanding).

The MDS indicated Resident 1 was dependent (helper does all the effort and resident does none of the effort to complete the activity) with toileting hygiene, and shower.

During a review of Resident 1 ' s Change in Condition (COC- when there is a sudden change in a resident ' s condition) Evaluation, dated 3/21/2025 at 7:50 a.m., the COC Evaluation indicated Resident 1 stated Resident 2, a roommate, scratched Resident 1 ' s right lower foot while Resident 2, seated on Resident 2 ' s wheelchair 1 while being wheeled out of Residents 1 and 2 ' s room by a staff member (name not indicated).

The COC Evaluation indicated there was a noted red line (no other descriptions indicated) in Resident 1 ' s right lower foot and staff (LVN 2) cleaned the skin area (the skin area with the red line).

555117

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 555117 B.

Wing 04/01/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Skyline Healthcare Center - LA 3032 Rowena Ave Los Angeles, CA 90039