Health inspection·April 13, 2023

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 Based on interview and record review the facility failed to follow their Policy when the licensed nurse failed to transcribe and follow physician treatment order for 1 of 3 sampled Residents (Resident 1) Residents Affected - Few This failure had the potential to place a clinically compromised Resident 1 health and safety at risk, when a Licensed nurse failed to transcribe and follow physician treatment order. Findings: During review of resident 1's admission Record (general demographics) on April 4,2023 , indicates admitted to facility on February 03, 2023 with diagnosis (DX) of Type 2 Diabetes Mellitus (body doesn't produce insulin), venous insufficiency ( failure of the veins to adequately circulate the blood especially from the lower extremities), congestive heart failure ( A chronic condition in which the heart doesn't pump blood as well as it should be), cellulitis of left lower limb ( A common and potentially serious bacterial skin infection), cirrhosis of Liver ( Chronic liver damage , leading to scarring and liver failure), chronic kidney disease ( Longstanding disease of the kidneys leading to renal failure), benign prostatic hyperplasia ( age-associated gland enlargement that can cause urination difficulty), Muscle weakness, Chronic Pulmonary Disease (block airflow, difficult to breathe), Obesity (over weight), Hyperlipidemia (high fats in blood). During review of Resident 1 History and Physical records from the admitting hospital on April 4, 2023, at 4:30PM, indicates, a handwritten verbal order from Physician (MD) stated, wrap leg with Ace wrap QD . During review of Resident 1 admission orders on April 4, 2023, at 4:40PM. There was no order of wrap leg with Ace wrap QD during review of MD1 admission order. During concurrent interview and record review of admission orders and MD 1's History and Physical ( H&P) with Director of Nursing (DON) on April 4, 2023, at 4:30PM, when asked, regarding the record review of the admission order for Resident 1; What is the expectation of your Admitting Nurse (LVN1) regarding transcribing orders? DON stated, to follow physicians' orders and transcribe it as order by the MD to the admission orders. During concurrent interview and record review with LVN1 on April 4,2023 at 5:05PM, when asked, if LVN 1 receives and transcribe a verbal order from MD for Resident 1 that states wrap leg with Ace wrap QD ? LVN 1 stated he received the order but forgot to transcribe the order to the admission orders. (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: 055299 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 055299 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Loma Linda Post Acute 25383 Cole Street Loma Linda, CA 92354 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)