Health inspection·April 23, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm or a body part) extending from her right upper leg to her foot. Resident A stated she was transferred by the staff from her bed to the geri-chair using the Hoyer lift on February 10, 2024. She stated she felt pain on her right foot when she was transferred to the geri-chair. Resident A further stated this was not the first time she had a fracture. Resident A stated that last year she broke her right ankle while being transferred from the Hoyer Lift. Resident A stated she was sent to the hospital. Residents Affected - Few On February 27, 2024, at 10:31 a.m., an interview with Certified Nursing Assistant (CNA) 1 was conducted. CNA 1 stated Resident A required two person assist with transfer using the Hoyer lift from her bed to the geri-chair or back. CNA 1 stated they had to be very careful with Resident A during transfer since she had severe osteoporosis and prone to fracture. CNA 1 stated Resident A had severe contracture of her right leg so when they transfer her in the Hoyer Lift, her entire right leg fits inside the lift sling (designed to hold the patient body while attached to the Hoyer lift). CNA 1 stated they do not use any other equipment, other than the Hoyer lift when they transfer Resident A. CNA 1 further stated they get Resident A out of bed two to three times a day because resident likes to go smoke in the patio. On February 27, 2024, at 12:19 p.m., an interview with CNA 2 was conducted. CNA 2 stated Resident A was transferred by her and another CNA from the bed to the geri-chair using the Hoyer lift on February 10, 2024, at around 1:40 p.m. CNA 2 stated when Resident A was transferred to the gerichair and was about to place a pillow to her right foot, Resident A complained of pain to her right foot and stated, I think my right foot is broken. CNA 2 stated that they were very careful and took their time moving resident since they were aware resident has severe osteoporosis. CNA 2 further stated they get Resident A out of bed using the Hoyer lift two to three times day since she likes to go to the patio and smoke. CNA 2 further stated she doesn't feel that it was safe to transfer Resident A using the Hoyer lift since she was prone to fracture. CNA 2 stated she broke her right leg before during transfer using the Hoyer Lift and was sent to the hospital. On February 27, 2024, Resident A's admission Record was reviewed. Resident A was admitted to the facility on [DATE], with diagnoses which included fracture of right femur, osteoporosis with current pathological fracture (a break in a bone that is caused by an underlying disease) of the right femur and lower leg, polio syndrome (an illness caused by a virus that mainly affects nerves in the spinal cord or brain which can lead to a person being unable to move certain limbs), deformity of the right ankle, contracture of the right knee, and absence of the leg above the knee. A review of Resident A's History and Physical, dated September 12, 2023, indicated Resident A had the capacity to understand and make decisions. A review of Resident A's Minimum Data Set (MDS - an assessment tool), dated December 12, 2023, indicated Resident A had a BIMS (Brief Interview of Mental Status) score of 13 (cognitively intact). A review of Resident A's Progress Notes, indicated the following: - September 8, 2023, at 4:04 p.m.; .CNA reported to CN (Charge Nurse) .resident c/o (complained of) pain to her foot, showed CN the discoloration and noted swelling as well. Both resident and CNA stated it had happened during the morning shift, but was not reported until PM shift .Recommendation: Stat x-ray (radiologic procedure used to examine the bones or organs inside your body) .; - September 8, 2023, at 11:46 p.m.; .resident to be sent to (name of hospital) r/t (related to) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055255 If continuation sheet Page 2 of 4 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 04/23/2024 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)

F 0689 xray result of fracture of R (right) tibia (shin bone) and fibula (calf bone) .; Level of Harm - Minimal harm or potential for actual harm -September 9, 2023, at 8:33 a.m.; .Resident returned back from hospital .Resident noted with soft cast to Left (sic) lower leg with Dx (diagnoses) of right tibia and fibula fracture . Residents Affected - Few A review of Resident A's Care Plan, initiated on September 10, 2023, indicated, .The resident at risk for fracture r/t (related to) severe osteoporosis, resident insists on getting up daily in to wheel chair to smoke .Goals .The resident will remain free of injuries or complications related to osteoporosis .Monitor/document/report PRN (as needed) s/x (signs and symptoms) or complication related to osteoporosis: Acute fracture .Provide with pillows, etc. to help maintain comfortable position . Further review of Resident A's care plan did not indicate specific interventions and safety measures to prevent fracture or injuries of the right leg related to the use of Hoyer lift during transfer. A review of the IDT (Interdisciplinary Team – a group of healthcare professionals) Progress Notes, dated September 11, 2023, at 3:06 p.m., indicated, .At around 4 pm .charge nurse reported to RN (Registered Nurse) .resident noted with swelling right ankle and right lower leg skin discoloration .initial interview with the resident by the charge nurse (sic), she informed the charge nurse (sic) that it happened in the morning during transfer in the hoyer lift .Resident is wheelchair bound and is occasionally smoke outside in the smoking patio .Resident was also interviewed numerous time. Resident is alert, oriented x (times) 3 (three), able to express her needs, verbally conversant .Resident during interview, she was on the Hoyer Lift when she heard a pop on her right lower ext (extremities) .Resident right lower ext (extremities) is contracted horizontally against her body. The DON able to talked to (name of doctor), he believed that resident already has osteoporosis that's why even with slight pressure or energy causes resident fracture .resident might have sustain fracture during the Hoyer Lift transfer, when it put pressure on her already fragile bone . Further review of Resident A's medical records indicated there was no documented evidence further assessment or evaluation was conducted to determine if Resident A was still safe to be transferred using the Hoyer Lift. There was also no evidence the facility had made attempts to use other equipment's and/or other interventions for transfer, other than the Hoyer Lift. A review of Resident A's Order Summary Report, dated January 2, 2024, included a physician's order, which indicated, Resident A may use Hoyer Lift for transfer. A review of the Progress Notes, dated February 10, 2024, at 2:46 p.m., indicated, .Resident was being transferred from her bed to a Geri chair, after transferring resident asked to put pillow under her R (right) leg, CNA placed pillow under her R knee and ankle .Resident stated my knee feels like its broke . A review of Resident A's Hospital Discharge Summary, dated February 10, 2024, indicated, .Patient states she was at her care facility .she heard a pop sound from her right knee and lower thigh area .Xray of the right knee showed acute (sudden onset) .fracture of the distal (away) femoral shaft (longer portion of a bone) . A review of Resident A's IDT Progress Notes, dated February 16, 2024, indicated, .Resident returned from (name of hospital), resident was transferred out, because during transfer from Geri chair to bed resident and CNA heard a pop at rt (right) leg .Resident returned to facility with Rt closed fracture to femur .Resident returned with full length hinged knee brace (provide a maximum level of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055255 If continuation sheet Page 3 of 4 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 04/23/2024 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)

F 0689 support to the knee) . Level of Harm - Minimal harm or potential for actual harm On February 28, 2024, at 2:08 p.m., interview with Director of Rehabilitation (DOR) was conducted. The DOR stated Resident A started Physical Therapy (PT) services on September 12, 2022, after she was admitted to the facility. The DOR stated Resident A had severe contractures of the right lower leg, flexed at the knee with internal rotation about 45 degrees. The DOR stated she was aware Resident A had severe osteoporosis and history of fracture of the lower leg prior to admission. The DOR stated she was not aware Resident A was sent to the hospital and sustained a fracture of the right lower leg on September 8, 2023. The DOR stated normally, if a resident sustained a fracture, they will be assessed and evaluated for mobility and transfer. In addition, the DOR stated special instructions and education will be provided to the nursing staff for safe transfer specific to the resident's needs once resident was to be discharged from PT services. The DOR stated Resident A required transfer using the Hoyer lift since admission and that this was the only option due to her severe contractures. The DOR stated Resident A was not assessed and evaluated to determine if resident was still safe and a candidate for transfer using the Hoyer lift after the first incident of fracture on September 8, 2023. Residents Affected - Few On March 6, 2024, at 2:02 p.m., an interview with the Director of Nursing (DON) was conducted. The DON stated Resident A had a fracture of the right lower leg while being transferred from the bed to the gerichair using the Hoyer lift on September 8, 2023. The DON stated per the IDT meeting conducted on September 11, 2023, the physician indicated that any slight pressure to the right lower leg could cause a fracture due her severe osteoporosis. The DON also stated when resident's right leg was positioned inside the sling on the Hoyer lift, could cause undue stress to her right lower leg from the Resident A's body weight in which could potentially cause a fracture. The DON stated after the first incident of fracture on September 8, 2023, Resident A continued to be transferred by staff using the Hoyer lift. The DON stated there were no other attempts to use other mode of transfer, other than the Hoyer lift since the first fracture on September 8, 2023. The DON stated Resident A was not evaluated and assessed by PT to determine if resident was still safe to be transferred using the Hoyer lift. The DON stated the PT/OT should have evaluated Resident A for continued use of the Hoyer lift after the resident sustained a fracture on September 8, 2023. The DON stated there was no recommendation from the IDT regarding alternative measures for transfer. The DON further stated there were no documentation an individualized care plan was developed for Resident A's to prevent fracture of the right leg while using the Hoyer lift. The DON stated an individualized care plan to prevent any injury while using Hoyer lift seocondary to osteoporosis for Resident A. A review of the facility's policy and procedure titled Safety and Supervision of Residents, dated July 2017, was reviewed. The policy indicated, .Our facility strives to make the environment as free from accident hazards as possible .Resident safety and supervision and assistance to prevent accidents are facility-wide priorities .Our individualized, resident-centered approach to safety addresses safety and accidents hazards for individual residents .The interdisciplinary care team shall analyze information obtained from assessments and observations to identify any specific accidents hazards or risks for individual residents .The care team shall target interventions to reduce individual risks related to hazards in the environment, including adequate supervision and assistive device .Implementing interventions to reduce accident risks and hazards shall include the following .Ensuring that interventions are implemented .Monitoring the effectiveness of interventions shall include the following .Modifying or replacing interventions as needed .Evaluating the effectiveness of new or revised interventions .Due to their complexity and scope, certain resident risk factors and environmental hazards are addressed in dedicated policies and procedures. These risk factors and environmental hazards include .Safe lifting and movement of residents . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055255 If continuation sheet Page 4 of 4