Health inspection·June 9, 2025

F 0776 Provide timely, approved x-ray services, or have an agreement with an approved provider to obtain them. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one of one sampled resident (Resident 1) who had an order of X-ray (an imaging test to create detailed pictures of the organs) of the left hand was implemented in a timely manner, as ordered. Residents Affected - Few This failure had the potential for Resident 1 not to receive necessary care and services to immediately meet the resident's medical needs. Findings: During a review of Resident 1's admission Record (AR), the AR indicated the facility admitted Resident 1 on 8/9/2023 and readmitted on [DATE] with diagnoses including dementia (a group of thinking and social symptoms that interfere with daily functioning), history of falling, and age-related osteoporosis (a medical condition in which the bones become brittle and fragile) During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool), dated 4/30/2025, the MDS indicated Resident 1 had severely impaired cognitive skills (ability to make daily decisions). The MDS indicated Resident 1 required substantial/maximal assistance (helper does more than half the effort) from staff for bathing and toileting hygiene. The MDS indicated Resident 1 required partial/moderate (helper does less than half the effort) assistance from staff for dressing and personal and oral hygiene. During a review of Resident 1's COC/INTERACT ASSESSMENT FORM (COC), dated 6/6/2025, the COC indicated Resident 1 had swelling of the left hand. The COC indicated Resident 1's physician (MD- medical doctor) ordered a STAT (immediate/urgent) x-ray of Resident 1's left hand on 6/6/2025 at 4:44 pm. During a review of Resident 1's physician's orders (PO) dated 6/6/2025, the PO indicated Resident 1's physician ordered STAT X-ray of Resident 1's left hand. The x-ray was ordered on 6/6/2025 at 4:38 p.m. During an interview on 6/9/2025 at 10:27 a.m. with the Director of Nursing (DON), the DON stated the DON asked Registered Nurse 1 (RN 1) to follow up on the results of Resident 1's left hand x-ray on 6/8/25 because the Radiology Technician (RT) had not done Resident 1's ordered x-ray. The DON stated the radiology company claimed Resident 1 was combative and uncooperative on 6/6/2025 when the RT tried to get the x-ray. The DON stated the RT did not inform the facility staff that the RT was unable to get the x-ray of Resident 1's left hand on 6/6/2025. Page 1 of 2 055126 055126 06/09/2025 Chino Valley Health Care Cente 2351 S Towne Avenue Pomona, CA 91766

F 0776 Level of Harm - Minimal harm or potential for actual harm During an interview on 6/9/2025 at 12:53 p.m. with the DON, the DON stated, STAT x-rays needed to be carried out within four hours from the time ordered. The DON stated the facility staff should have followed up on Resident 1's left hand x-ray results when the results were not received within four hours of the x-ray being ordered. The DON stated the RT should have informed Resident 1's licensed nurse if the RT was not able to get the x-ray of Resident 1's left hand. Residents Affected - Few During a telephone interview on 6/9/2025 at 1:32 p.m. with RN 1, RN 1 stated RN 1 put in the order for x-ray of Resident 1's left hand on 6/6/2025. RN 1 stated the RT arrived at the facility after 8:00 p.m. on 6/6/2025 to get the x-ray of Resident 1's left hand. RN 1 stated RN 1 assisted the RT to get the x-ray of Resident 1's left hand. RN 1 stated the RT asked RN 1 to step out of the room during the x-ray procedure. RN 1 stated RN 1 walked the RT out of the facility and the RT did not inform RN 1 that the RT was not able to get the x-ray of Resident 1's left hand. RN 1 stated RN1 called the radiology company for Resident 1's x-ray results later on 6/6/2025 but was not able to speak to anyone. RN 1 stated RN 1 was off the next day (6/7/2025) and returned to work at the facility on 6/8/2025. RN 1 stated RN 1 was notified on 6/8/2025 that Resident 1 did not get an x-ray as ordered on 6/6/2025. During a review of the facility's Policy and Procedure (P&P) titled, Availability of Services, Diagnostic, revised December 2009, the P&P indicated, clinical laboratory and radiology services meet the needs of the residents provided by the facility. The P&P indicated radiology services were available 24 hours a day, 7 days a week, including holidays. During a review of the facility's P&P titled, Request for Diagnostic Services, revised December 2009, the P&P indicated, Orders for diagnostic services will be promptly carried out as instructed by the physician's order. 055126 Page 2 of 2