Health inspection·May 20, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to cross check discharge medications according to the facility policy for one of four residents (Resident 4), when a Licensed Vocational Nurse (LVN 1) improperly transferred Resident 4's Atorvastatin (a medication intended to lower cholesterol and prevent strokes, heart attacks, and chest pain), as well as Eliquis (a blood thinner that reduces blood clotting) to the caregiver of Resident 1 during discharge, despite Resident 1 not being prescribed these medications. Residents Affected - Few This failure led to the loss of medications and increased the risk of a stroke for Resident 4, while also exposing Resident 1 to potential adverse effects from the medications, which could result in injury and harm. Findings: During a review of Resident 4's clinical record, the face sheet (contains demographic and medical information), indicated Resident 4 was admitted on [DATE], with diagnoses that included hypertensive heart disease with heart failure (the heart is failing to pump blood effectively, and this is due to long-term high blood pressure). During a review of the clinical record for Resident 4 ' s the Brief Interview for Mental Status (BIMSscreening tool to identify and monitor cognitive decline), dated March 12,2025, indicated, Resident 4 ' s score was a 13, which indicated Resident 4 had no mental impairment. During a review of Resident 1's clinical record, the face sheet (contains demographic and medical information), indicated Resident 1 was admitted on [DATE], with diagnoses that included Encephalopathy (a change in how your brain functions), Cirrhosis of Liver (a lot of scars on your liver making it hard for the liver to do its job). During a review of the clinical record for Resident 1 ' s the Brief Interview for Mental Status (BIMSscreening tool to identify and monitor cognitive decline), dated March 12,2025, indicated, Resident 1 ' s score was a 12, which indicated Resident 1 had moderate cognitive impairment (there are significant changes in thinking and memory that begin to interfere with daily life and independence). During a concurrent telephone interview and record review on May 16, 2025, at 10:46 PM, with the LVN 1, the LVN 1 stated on the day of discharge, she inadvertently provided two medication carts belonging to Resident 4 to the caregiver of Resident 1, who had come to pick up Resident 1. She handed over two carts, one of which contained Atorvastatin, while she overlooked the other medication. She further stated that the Social Worker Director (SWD 1) later reported that the family indicated 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: 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 05/20/2025 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)