Inspection·December 7, 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 observation, interview, and record review, the facility failed to protect one of three sampled residents (Resident 1) from injury when the Certified Nurse Assistant 1 (CNA 1) was assisting Resident 1 from a standing position and held Resident 1 with one hand, while reaching for the wheelchair with the other hand during transfer from bed to wheelchair. Resident 1's knees lost postural stability while standing. This failure resulted in Resident 1 falling and sustaining a fractured pelvis (hip bone). Findings: During an interview of on December 7, 2023, at 1:35 PM with Resident 1, Resident 1 stated she had a fall incident, but was unable to give details about it. During a review of Resident 1's admission Record (AR) , dated December 7, 2023, the AR indicated Resident 1 was admitted to the facility on [DATE], with diagnoses that included senile (poor mental ability because of old age) degeneration of brain and hemiplegia (paralysis on one side of the body) and hemiparesis (weakness on one side of the body) following cerebral infarction (disrupted blood flow to the brain) affecting left non-dominant side. During a review of Resident 1's History and Physical (H&P-a brief documentation of a resident's medical condition), dated November 27, 2023, the H&P indicated, Resident 1 has fluctuating capacity to understand and make decisions. During a review of Resident 1's Section GG- Functional Abilities and Goals, dated November 9, 2023, the Section GG indicated Resident 1 uses wheelchair for mobility and requires partial/moderate assistance during transfers from bed to wheelchair. During a concurrent interview and record review on December 7, 2023, at 4:06 PM with the Director of Nursing (DON), Resident 1's Progress Notes (PN), dated November 17, 2023, was reviewed. The PN indicated, Patient (Resident 1) fell on floor on left side of body during a transfer from bed to wheelchair. CNA turned around to reach for the wheelchair when patient fell . The DON stated the CNA referred on the PN is CNA 1. The DON stated CNA 1 was assisting Resident 1 with both hands while standing up from bed when CNA 1 turned and grabbed the wheelchair with her right hand. Resident 1's legs lost stability while standing and fell to the floor while being held by CNA 1. The DON further stated Resident 1 was eventually sent to the hospital on the same day. During a record review on December 7, 2023, at 4:25 PM with the Director of Nursing (DON), Resident 1's Adult Trauma H&P/Consult from (Name of Hospital), dated November 18, 2023, was reviewed. The (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 12/07/2023 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)