Health inspection·March 13, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to report two of three sampled residents (Resident 1 and Resident 2) per their policy and procedure to the California Department of Public Health (CDPH) of alleged abuse, when a staff member allegedly twisted Resident 1's wrist and when a Certified Nurse Assistant (CNA) allegedly pushed Resident 2's leg forcibly while on a mechanical lift resulting in pain . This failure has potential to affected (Resident 1 and Resident 2)'s health, safety, and well-being. Findings: During review of Residents 1's admission Record (general demographics), the document indicated Resident 1 was admitted to the facility on [DATE], with diagnoses that included hemiplegia and hemiparesis after cerebrovascular disease affecting left side ( paralysis and weakness on one side of the body after stroke),hypertensive heart disease with heart failure (heart conditions caused by high blood pressure that leads to the heart's inability to pump enough blood), chronic obstructive pulmonary disease ( lung disease that block airflow and make it difficult to breath), depression (a condition of feeling of sadness). During an interview on March 11, 2025, at 10:15 AM, with Resident 1 (Resident 1). Resident 1 stated that Licensed Vocational Nurse 1 (LVN 1) twisted her right wrist while trying to grab her phone to turn it off. Resident 1 stated that her phone was somehow got connected to the facility's overhead speaker. Resident 1 stated she made Charge Nurse (CN 1) aware of the incident and was complaining of a burning sensation on right wrist. During a phone interview on March 11, 2025, at 11:20 AM, with LVN 1, the LVN 1 stated that he was only trying to get Resident's 1 phone to turn it off. LVN 1 stated I did not twist her right wrist; I did not even touch her. I was only trying to help her turn off the phone and she started screaming and crying . LVN1 stated that Administrator (ADM) and Director of Nursing (DON) was notified. During a phone interview on March 11, 2025, at 12:20 PM with Charge Nurse1 (CN1), the CN1 stated she heard voices from the overhead speaker and went to the resident's room to check what was happening. She met with the Registered Nurse 1 (RN 1) in the room. Resident 1 stated that LVN 1 twisted her right wrist. CN1 stated they reported the incident to the Administrator (ADM). During review of Resident 2's admission Record, the documents indicated Resident 2 was admitted to the facility on [DATE], with diagnoses that included chronic obstructive pulmonary disease ( lung (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: 055213 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 055213 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rialto Post Acute Center 1471 S Riverside Ave Rialto, CA 92376 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)