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Complaint Investigation

Ararat Nursing Facility

Inspection Date: September 9, 2025
Total Violations 1
Facility ID 555579
Location MISSION HILLS, CA
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Inspection Findings

F-Tag F0609

Freedom from Abuse, Neglect, and Exploitation Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Based on interview and record review, the facility failed to report an allegation of an employee-to-resident verbal abuse (harsh and insulting language directed at a person) and physical abuse (deliberately aggressive or violent behavior with the intention to cause harm) within two hours to the State Survey Agency (SSA) for one of three sampled residents (Resident 1). Certified Nursing Assistant (CNA) 1 reported an allegation of abuse to the Director of Nursing (DON) that allegedly occurred on 8/5/2025, committed by Life Enrichment Coordinator (LEC) 1 towards Resident 1. The facility reported the allegation of abuse to the SSA on 8/29/2025, 24 days after the allegation of abuse was made.This deficient practice had the potential to result in unidentified abuse and failure to protect other residents from abuse.Findings:During a review of Resident 1's admission Record (undated), the admission Record indicated the facility admitted the resident on 2/10/2023 with diagnoses including hemiplegia (inability to move one side of the body) and hemiparesis (weakness on one side of the body) following cerebral infarction (damage to tissues in the brain due to a loss of oxygen to the area) affecting the right dominant side, type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar [glucose]), and dysphagia (a condition that makes it difficult to swallow).During a review of Resident 1's Minimum Data Set (MDS - resident assessment tool), dated 6/25/2025, the MDS indicated Resident 1's cognition (refers to conscious mental activities including thinking, reasoning, understanding, learning, and remembering) was moderately impaired. During an interview on 9/9/2025 at 12:04 p.m. with RNA 1, RNA 1 stated he saw LEC 1 threw a towel or sweater at Resident 1's face in the dining room. RNA 1 stated he heard LEC 1 yelling at Resident 1. RNA 1 stated LEC 1's actions were considered an alleged verbal and physical abuse. RNA 1 stated he reported the alleged verbal and physical abuse to the DON on 8/29/2025.

During an interview on 9/9/2025 at 4:05 p.m. with the Assistant Administrator (AADM), the AADM stated he was the facility's Abuse Coordinator. The AADM stated on 8/29/2025, RNA 1 reported the allegations of verbal and physical abuse that allegedly happened on 8/5/2025. The AADM stated RNA 1 should have reported the allegations of abuse within two hours. The AADM stated he was aware allegations of abuse must be reported within two hours to the SSA, Ombudsman, and law enforcement. During an interview on 9/9/2025 at 4:34 p.m. with the Director of Nursing (DON), the DON stated on 8/29/2025, RNA 1 informed her about the allegation of abuse by LEC 1 to Resident 1 on 8/5/2025. The DON stated not reporting allegations of verbal and physical abuse had the potential for the abuse to continue. The DON stated RNA 1 failed to report the allegation of abuse within 2 hours that led to the facility reporting the allegations on 8/29/2025. During a review of the facility's policy and procedure (PnP) titled, Abuse Prevention and Prohibition Program, last reviewed on 7/23/2025, the PnP indicated, the facility will report allegations of abuse . immediately. no later than two hours after forming the suspicion.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE

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(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

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📋 Inspection Summary

Ararat Nursing Facility in MISSION HILLS, CA inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in MISSION HILLS, CA, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from Ararat Nursing Facility or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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