Inspection·August 22, 2023

F 0689 Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure staff followed the Policy and Procedure (P&P) titled Lifting machine, using a mechanical when transferring residents from the bed to a chair for two out of three residents (Residents 1 and 2). A mechanical lift is a metal assistive device with a U-shaped base, an overhead bar and a sling that work together to lift, reposition, and lower a resident into a chair or a bed. On 6/23/2023, Resident 1 was being transferred with a mechanical lift from her bed to a shower chair by one staff member (Certified Nursing Assistant (CNA) A). During the transfer, one of the straps from the sling became disconnected, which resulted in Resident 1 falling out of the sling onto the floor. Resident 1 sustained head injuries and lacerations to the left arm, requiring an emergency room transfer and admission to the hospital. Resident 2 also required a mechanical lift transfer. During an interview on 6/28/2023, Resident 2 stated that approximately 2-3 times a month, only one staff member uses a mechanical lift to transfer her from the bed to the chair. The failure to ensure two staff members were present during mechanical lift transfers resulted in Resident 1 to fall, sustained head injuries and lacerations to the left arm, requiring an emergency room transfer and admission to the hospital. This failed practice also had the potential for other residents that use the lift to fall. Findings: On 6/26/2023 at 8:42 a.m., the facility notified the California Department of Public Health that on 6/23/2023, at approximately 3:35 p.m., Resident 1 sustained lacerations to her left forearm, laceration to the bottom of her lip, bruising to her right arm/elbow and crepitus (grating sound) to an area above her eyebrow after falling from a mechanical lift to the ground. Clinical record review for Resident 1 was conducted on 6/28/2023. Review of Resident 1's Emergency Department Provider Report, dated 6/23/2023, indicated Resident 1 was brought to the emergency room after falling from a mechanical lift at the skilled nursing facility. The resident groaned in discomfort. Examination of her head indicated a laceration to her right forehead region requiring suture repairs, a right eye hematoma (bleeding around the eye), abrasion to the lips and dried blood in her mouth. Her left lower leg had a small hematoma on the front of her shin. A computerized tomography (CT scan - combines a series of X-ray images taken from different angles around the body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside the body. CT scan images provide more-detailed information than plain X-rays do.) indicated Resident 1 also sustained a right-sided subdural hemorrhage (bleeding in the brain). Review of Resident 1's hospital Neurosurgery (medical discipline that specializes in surgery performed on the nervous system, especially the brain and spinal cord) Consultation Note, dated 6/23/2023, (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 4 Event ID: 055240 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 055240 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Watsonville Nursing Center 535 Auto Center Drive Watsonville, CA 95076 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)