F0609

D

Failure to Timely Report Alleged Abuse to CDPH

San Diego, California Survey Completed on 03-19-2026

Penalty

No penalty information released

Summary

The facility failed to timely report an allegation of abuse involving Resident 1 to the California Department of Public Health (CDPH) within two hours of the initial allegation. Resident 1, who had an anxiety disorder and required assistance with personal care, reported that during an evening bed bath on 3/4/26, a CNA attempted to slap her when she objected to how her gluteal area was being cleaned. Resident 1 stated she raised her hand to protect her face and her imitation fingernail on the right pinky broke. She reported the incident that night to a licensed nurse at about 10 P.M., and the following day discussed the incident with the Social Services Assistant (SSA). The SSA overheard Resident 1 describing that the CNA was not following her instructions on how to clean her, and that when Resident 1 raised her hand, the CNA hit her and broke her nail.

The Behavior Note by Licensed Nurse 1 on 3/4/26 documented Resident 1 making threatening verbal statements toward a CNA during care, speaking in a raised voice, appearing agitated, and stating, "You are not doing the right thing and I will report you," with the supervisor notified. The Administrator (ADM) acknowledged being informed of the incident by the licensed nurse on the night of 3/4/26 and again by the SSA on 3/5/26 at about 4 P.M., but did not report the alleged abuse to CDPH within the required two-hour timeframe. The SOC 341 report was not sent until 3/6/26 at 3:59 P.M., despite the facility’s abuse-reporting policy stating that the Administrator or designee will notify CDPH by telephone within two hours of an allegation of abuse with no serious bodily injury. The ADM stated that the expectation was to report any alleged abuse to CDPH within two hours of the allegation being made and recognized the importance of this requirement.