Health inspection·January 22, 2026

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure sensor alarms (wireless bed alarms that alert staff when a patient gets up from the bed so staff can go and assist the patient, used to prevent falls) were functioning for, two of four sampled residents (Resident 2 and Resident 3), who were at high risk for falls.This deficient practice had the potential to result in falls and injuries to Resident 2 and Resident 3. Findings:During a review of Resident 2's admission Record (AR), the AR indicated the facility admitted Resident 2 on 4/20/2021, with diagnoses that included dementia (long term and often gradual decrease in the ability to think and remember severe enough to affect a person's daily functioning), other abnormalities of gait, and mobility.During a review of Resident 2's Minimum Data Set (MDS- a resident assessment tool), dated 1/8/2026, the MDS indicated Resident 2 was able to express ideas and wants, understood verbal content, and had problems with short-term and long-term memory. The MDS indicated Resident 2 was dependent on activities of daily living.During a review of Resident 2's Morse Fall Scale dated 1/8/2026, the scale indicated Resident 2 was at high risk for falling.During a review of Resident 2's care plan (CP), revised 1/8/2023, the CP indicated Resident 2 was at risk for falls related to impaired balance, impaired mobility, and trying to get out of bed unassisted. The CP's interventions included a motion sensor [alarm] in Resident 2's room.During a review of Resident 3's AR, the AR indicated the facility admitted Resident 3 9/25/2025, with diagnoses that included history of falling and muscle weakness.During a review of Resident 3's CP, initiated 9/26/2025, the CP indicated Resident 3 was at risk for recurrent falls related to impaired balance and impaired mobility. The CP indicated on 12/23/2025, Resident 3 was assisted slowly to the floor (assisted fall) due to Resident 3 trying to walk without calling for [staff assistance] and Resident 3's legs gave out while walking. The CP's interventions included a motion sensor [alarm].During a review of Resident 3's MDS, dated [DATE], the MDS indicated Resident 3 had intact cognition and required maximal assistance (helper lifts or holds trunk or limbs and provide more than half the effort).During a review of Resident 3's Change in Condition (COC), dated 12/23/2025 at 9 AM, the COC indicated an unidentified Certified Nursing Assistant (CNA) reported Resident 3 had a fall. During a review of Resident 3's Morse Fall Scale (widely used, evidenced based nursing tool designed to assess a patient's risk of falling), dated 12/30/2025, the scale indicated Resident 3 was at high risk for falling.During a concurrent interview and observation on 1/22/2026 at 10:54 AM, CNA 2 stated CNA 2 had 2 alarms for Resident 2 and Resident 3. CNA 2 pulled out 2 white alarms from inside CNA 2's pocket.During an interview on 1/22/2026 at 1:16 PM, CNA 1 stated the sensor alarms needed to be positioned facing the resident (in general) to monitor and detect the resident's motion. CNA 1 stated [it was facility practice for] CNA's (in general) to carry a white device (paired with the sensor alarms located inside resident rooms) and respond when the device made an audible sound (triggered by motion in front of the sensor alarm), by checking (visually) on the resident.During an (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 2 Event ID: 055016 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 055016 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/22/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mount San Antonio Gardens 900 E. Harrison Ave Pomona, CA 91767 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)