Health inspection·February 6, 2025

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record reviews, the facility failed to maintain infection control practices for one of thirty-nine residents (Resident 60), when Resident 60's oxygen tubing (a thin, flexible tube that delivers oxygen to a patient during oxygen therapy) it had not been changed every seven (7) days, as per facility policy. Residents Affected - Few This failure placed Resident 60 at risk for developing a respiratory infection (caused by bacteria, viruses, fungi, or parasite). Findings: During a review of Resident 60's admission Record (clinical record with demographic information), the admission Record indicated, Resident 60 was admitted on [DATE], with the diagnoses of acute respiratory failure (a serious condition that makes it difficult to breathe on your own), pleural effusion (a collection of fluid around your lungs), chronic obstructive pulmonary disease (COPD-a chronic lung disease causing difficulty in breathing). During a concurrent observation and interview on February 3, 2025, at 11:02 AM, with Licensed Vocational Nurse 2 (LVN 2), in Resident 60's room, Resident 60 was laying down, asleep, and using oxygen via nasal cannula (a small, flexible tube that contains two open prongs intended to deliver oxygen into the nares). There was a wheelchair on the left side of Resident 60's room with an e-tank (a container with oxygen inside) with a bag that contained oxygen tubing dated January 23, 2025. LVN 2 stated the oxygen tubing was dated January 23, 2025, and it should have been changed. During an interview on February 6, 2025, at 9:12 AM, with the Infection Preventionist (IP), the IP stated central supply staff and the certified nursing assistants change the oxygen tubing and humidifiers every Thursday. The Infection Preventionist further stated the oxygen tubing should have been changed on January 30, 2025, and it was four days late. During an interview on February 6, 2025, at 9:45 AM, with the Director of Nursing (DON), the DON stated the oxygen tubing should have been changed. The DON further stated, We missed that one. During a review of Resident 60's, Order Summary Report dated January 1, 2025, indicated Oxygen-change nasal cannula every week and also PRN (PRN-as needed). During a review of the facility policy and procedure (P&P) titled, Prevention of Infection Respiratory Equipment, dated November 2011, the P&P indicated, Purpose . The purpose of this procedure is to guide prevention of infection associated with respiratory therapy tasks and equipment among (continued on next page) 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 TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 3 Event ID: 055001 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055001 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redlands Healthcare Center 1620 W Fern Ave Redlands, CA 92373 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)