Health inspection·August 3, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to follow Policy on reporting when one of three sampled Resident's (Resident 1) eloped from facility. This failure had the potential to cause serious health and psychosocial harm to a clinically compromised Resident (Resident 1). Findings: During review of resident 1s admission Record (General demographics) on ., indicates admitted to facility on June 23, 2023, with diagnosis (DX) of Primary Osteoarthritis (caused by the breakdown of cartilage, a rubbery material that eases the friction in your joints), Diabetes (a disease that occurs when your blood glucose, also called blood sugar, is too high), Rheumatoid Arthritis (the body's immune system attacks its own tissue, including joints. In severe cases, it attacks internal organs) Gout (occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain) and Edema (occurs when tiny blood vessels in the body, also known as capillaries, leak fluid). During concurrent interview on June 30, 2023, at 1:00 PM with Director if Nursing (DON) and Administrator, they both stated the resident was only gone for 2 hours, resident walked home to get his hat . Resident resides 3 miles from the facility. They both states they did not report it because the resident was only gone for 2 hours, and he came back on an Uber. During an interview on July 10, 2023, at 11:15 AM with Licensed Vocational Nurse (LVN 1), he stated the resident left facility without notifying anyone. States they went to VA Hospital, and surrounding areas to locate resident and he was nowhere to be found. The sheriff's department was called, and they arrived and looked for resident also. Later that evening the resident arrived at facility with a hat on stating he went home to get hat. During record review, Progress Notes on June 25.2023 1745 by LVN 2, indicated 1745 attention was brought by Charge Nurse (CN) on duty that resident is not in his room, and he checked all room and around the building. Asked Certified Nursing Assistant (CAN 1) on duty at the time saying the resident at 1630 PM he saw resident on the hallway and asked him where you are going? Resident 1 said I'm walking around. This writer (LVN 2) called Acute ER. San [NAME] police notified at (number of police station ins San [NAME]) spoke with dispatcher all information's about the resident given. at 1809 I called Acute ER to check, triage told me resident not there. Doctor notified at 1818. Resident's daughter phone number unable to leave a message as it states busy. DON and administrator made aware. At 1847 Deputy Sheriff 1 from San [NAME] in the facility and reported given at 1921, I called San [NAME] (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 08/03/2023 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)