Health inspection·March 28, 2024

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to provide one of three sampled residents a written notification of bed hold at transfer to the hospital. This deficient practice resulted on resident (Resident 1) not receiving notification of the right to return to a bed at the facility. Findings: Resident 1 was admitted to the facility on [DATE] with a diagnosis of bipolar disorder (a disorder of the brain that affects mood and behavior) per the admission record. A review of the facility census on 3/12/24 indicated Resident 1 was no longer residing at the facility. A review of the facility admission/discharge report indicated Resident 1 was discharged to an acute care hospital on 2/5/24. On 3/12/24 at 11:22 A.M., an interview and review of Resident 1's medical record was conducted with the social service director (SSD). The SSD stated the facility was required to provide all residents with a written notification of the seven-day bed hold policy on admission and transfer to the hospital. The medical record indicated Resident 1 was not provided with written notification of the facility's seven day behold notification policy upon transfer to the acute care hospital on 2/5/24. The SSD stated Resident 1 should have been provided written notification upon transfer. On 3/12/24 at 12:23 P.M., a telephone interview was conducted with the Administrator (Admin). The Admin stated the facility was required to provide a seven day bed hold to Resident 1 in writing upon transfer to the hospital. A review of Resident 1's progress notes, dated 2/5/24 and 2/6/24, did not indicate Resident 1 was informed of seven-day bed hold provisions at the time of transfer within the first 24 hours following transfer to the acute care hospital. A review of the facility document titled, Notice of Proposed Transfer/Discharge form, dated 2/5/24, indicated the facility did not notify Resident 1 of seven-day bed hold provisions at the time of transfer to the acute care hospital. A review of the facility policy and procedure titled Bed Hold, undated, indicated, .the facility shall inform the resident, or the resident's representative, in writing of the right to exercise the (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: 055067 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 055067 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palomar Vista Healthcare Center 201 N Fig Street Escondido, CA 92025 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)