Health inspection·January 5, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to complete a breathing treatment as ordered for two of two sampled residents (1, 2). As a result, the residents had a risk of decreased lung function. Findings: 1 Per the facility's admission Record, Resident 1 was admitted to the facility on [DATE] with diagnoses to include Chronic Respiratory Failure (difficulty breathing). Per the facility's Pulmonary Orders treatment log, dated 12/22/23, there was an order for staff to complete the incentive spirometer (a device to improve the ability to breathe) with Resident 1 four times per day. From 12/1 through 12/22/23 there were 85 opportunities to sign that the task was completed, and nine of the opportunities were left unsigned. 2 Per the facility's admission record, Resident 2 was admitted to the facility on [DATE] with diagnoses to include heart failure. Per the facility's Pulmonary Orders treatment log, dated 12/22/23, there was an order for staff to complete the incentive spirometer (a device to improve the ability to breathe) with Resident 2 four times per day. From 12/1 through 12/22/23 there were 85 opportunities to sign that the task was completed, and nine of the opportunities were left unsigned. On 1/5/24 at 9:48 A.M., a telephone interview and record review of the Pulmonary Orders treatment log was conducted with the Director of Staff Development (DSD). The DSD stated, the nurses who did not sign the log either did not know they were supposed to do it, or they forgot. The DSD further stated, the Incentive Spirometer should have been signed on the treatment log. 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: 055078 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 055078 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkway Hills Nursing & Rehabilitation 7760 Parkway Drive LA Mesa, CA 91942 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)