Health inspection·August 16, 2023

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. 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 monitor and assess Resident 1 ' s surgical staples on the resident ' s surgical incision (a cut made through the skin and soft tissue to facilitate an operation or procedure) in the right upper hip for one of two sampled residents (Resident 1) in accordance with professional standards of practice. Residents Affected - Few The facility ' s licensed nurses did not complete an assessment or monitor Resident 1 ' s surgical staples after Resident 1 ' s right hip surgery since admission to the facility. This deficient practice had the potential for increased risk for infection from Resident 1 ' s surgical wound with prolonged staples. Findings: A review of Resident 1 ' s Face Sheet indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including fracture of unspecified part of neck of right femur (the bone of the thigh), subsequent encounter for closed fracture (the bone is broken, but the skin is intact) with routine healing, chronic obstructive pulmonary disease (COPD; a group of lung diseases that block airflow and make it difficult to breathe). A review of Resident 1 ' s admission reassessment dated [DATE], indicated Resident 1 most recent admission 5/18/23 at 7:20 PM with a surgical incision on right upper hip measuring 17.2 centimeters (cm; a unit of measurement) in length, 0.1 centimeter wide. The admission reassessment indicated that Resident 1 was noted with right upper hip surgical incision and was on wound vacuum machine (type of therapy that uses a machine to gently pull fluid from the wound over time). A review of Resident 1 ' s Non-Pressure Sore Skin Problem report with effective date of 5/19/23, weekly progress report section indicated the following information: 1. 5/24/23 the reportindicated Removed the wound vac, and wound site clean, no discharge, no redness. Surgical site has staples on it, and intact. 2. 5/25/23 the report indicated Resident 1 seen by nurse practitioner (NP 1) and noted with right upper hip surgical incision, no new order. Clean with normal saline pat dry, paint with Betadine cover with dry dressing. The Report did not indicate further documented evidence after 5/5/23 through 6/15/23 (Resident 1 ' s discharge) while Resident 1 resides at the facility, that showed an assessment of Resident 1 ' s surgical hip wound that mentioned if staples were still intact. (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: 055135 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 055135 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/16/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Montrose Healthcare Center 2123 Verdugo Blvd. Montrose, CA 91020 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)