Health inspection·January 12, 2024

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a care plan was developed to include hip precautions following a right hip arthroplasty (hip replacement surgery, a type of joint replacement surgery), for one of three residents reviewed (Resident 1). This failure had the potential for the staff to not be aware of the interventions to be implemented to prevent complications related to the hip surgery of Resident 1. This failure had the potential for Resident 1 to experience post hip surgery complications (i.e. dislocation of the right hip, fracture [broken bone]). Findings: On November 30, 2023, at 10:40 a.m., an unannounced visit was conducted at the facility to investigate a facility reported incident and a complaint intake. On November 30, 2023, at 2:28 p.m., Resident 1' s record was reviewed. Resident 1 was admitted to the facility on [DATE], with diagnoses which included aftercare following joint replacement surgery, acute hematogenous osteomyelitis (bone infection in regions of the bone with the most blood supply, with symptoms occurring within less than two weeks) multiple sites, and osteoporosis (bone becomes brittle and fragile). There was no documented evidence a care plan was developed to address interventions to prevent complications related to post hip replacement which included for the staff to implement hip precautions on Resident 1. The Progress Notes, dated November 16, 2023, at 3:51 p.m., indicated, .right hip surgical wound increase pain, increase drainage, swollen noted . The Radiology Results Report, dated November 17, 2023, indicated a dislocation of the right hip arthroplasty.The physician ' s order, dated November 17, 2023, indicated an order to transfer Resident 1 to the acute hospital for further evaluation and treatment. On November 30, 2023, at 2:28 p.m., a concurrent interview and review of Resident 1 ' s care plans was conducted with the Director of Nursing (DON). The DON stated there was no care plan specific to hip precautions. He stated there should have been a care plan to indicate use of hip precautions for Resident 1. (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: 055255 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 055255 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corona Health Care Center 1400 Circle City Drive Corona, CA 92879 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)