Inspection·December 13, 2023

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure one of three residents, (Resident 3), was assisted with his meal in a dignified manner when the Certified Nursing Assistant (CNA 2), stood over the resident. This failure caused Resident 3 to feel rushed and had the potential for compromised dignity. Findings: On November 29, 2023, at 11:48 a.m., an unannounced visit to the facility on a complaint investigation was initiated. On November 29, 2023, at 1:15 p.m., observed Resident 3 sitting in a wheelchair in the hallway. Resident 3's lunch tray was on the over-bed table in front of Resident 3. CNA 2 was standing beside Resident 3 as he was feeding Resident 3. On November 29, 2023, at 1:34 p.m., an interview was conducted with Resident 3. Resident 3 stated he needed assistance with eating his lunch. Resident 3 stated he felt rushed while CNA 2 was assisting him with lunch. On November 29, 2023, at 1:58 p.m., an interview was conducted with CNA 2. CNA 2 stated that he should have been seated while assisting Resident 3 with his lunch. A review of Resident 3's medical record indicated he was admitted on [DATE], with diagnoses of amyotrophic lateral sclerosis, (ALS - is also called Lou Gehrigsdisease. It's a neuromuscular disorder that causes muscle weakness), anxiety disorder, (a chronic condition characterized by an excessive and persistent sense of apprehension), and major depression, (a mood disorder that causes a persistent feeling of sadness and loss of interest). A review of Resident 3's History and Physical dated January 31, 2023, indicated he had the capacity to understand and make decisions. A review of Resident 3's Care Plan initiated May 23, 2023, indicated Focus . The resident has an ADL self-care performance deficit r/t Limited Mobility, Weakness secondary to left humerus fracture (history), Amyotrophic Lateral Sclerosis .Interventions . EATING: Extensive with one person assist . A review of a Nursing Times article titled Assisting Patients with Eating and Drinking to Prevent (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: 055042 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 055042 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alta Vista Healthcare & Wellness Centre 9020 Garfield Street Riverside, CA 92503 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)