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F0558
D

Failure to Provide TV Remote Control Leads to Resident Altercation

San Diego, California Survey Completed on 06-24-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to reasonably accommodate the needs and preferences of a resident by not ensuring that each resident in a shared room had access to their own TV remote control. On the date of the incident, there were only two TV remote controls available for three beds, and at the time, only one remote was present. One resident became upset after being unable to locate the TV remote control and asked his roommate about its whereabouts. This interaction led to a physical altercation, with the resident being struck in the chest by his roommate. The incident was subsequently reported as a physical abuse case to the California Department of Public Health (CDPH). Interviews with staff revealed that the resident had asked for assistance in locating the missing TV remote control, but no staff member assisted him. The Maintenance Director was unaware that the room was lacking sufficient TV remote controls and stated that no work order had been submitted for a replacement. Facility policy requires staff to assist residents in maintaining independence, dignity, and well-being, including accommodating individual needs and preferences. However, staff failed to provide the necessary support, resulting in the altercation between residents.

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