Health inspection·January 8, 2026

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. Based on observation, interview and record review, the facility failed to ensure that Certified Nursing Assistant 1 (CNA 1), CNA 2, and Licensed Vocational Nurse 1 (LVN 1) responded in a timely manner to requests for assistance to the bathroom for one of one resident (Resident 4). This deficient practice resulted in Resident 4 having unmet needs. Findings: During a review of Resident 4' s admission Record (AR), the AR indicated the facility admitted Resident 4 on 11/6/2025, with diagnoses that included traumatic hemorrhage of the cerebrum (bleeding in the brain), muscle weakness, and lack of coordination. During a review of Resident 4's Minimum Data Set (MDS - a federally mandated resident assessment tool), dated 11/13/2025, the MDS indicated Resident 4 had moderately impaired cognition (a level of cognitive decline). The MDS indicated Resident 4 was dependent with rolling left and right, chair/bed-to-chair transfer. During an observation on 1/8/2026 from 1:16 PM to 1:25 PM, Resident 4 was sitting in a wheelchair at the foot of the bed, facing away from the door, and was yelling repeatedly, Can I go to the bathroom, 16 times. During an observation on 1/8/2026 at 1:18 PM, CNA 1 entered Resident 4's room, looked around the room, while Resident 4 was yelling, Can I go to the bathroom, CNA 1 did not communicate with Resident 4 and left the room. During an observation on 1/8/2026 at 1:21 PM, CNA 2 entered Resident 4's room, but did not assist Resident 4 with toileting. CNA 2 did not communicate with Resident 4 and left the room. Resident 4 continued to repeatedly yell, Can I go to the bathroom. I just want to go to the bathroom. Resident 4 stated, I would make a mess and you going to be stuck with it. During an observation on 1/8/2026 at 1:24 PM, LVN 1 was standing in front of the medication cart located in the hallway close by Resident 4's room while Resident 4 continued to call out, Can I go to the bathroom. LVN 4 started to prepare medications and then entered Resident 4's room to administer medications. During an observation on 1/8/2026 at 1:27 PM, the Director of Nursing (DON) stated staff needed to assist Resident 4 once they heard him asking for assistance to the bathroom. The DON stated that they need to stop and notify the assigned CNA. The DON stated if the staff member who heard the resident calling was not the staff assigned to Resident 4, they needed to inform the assigned staff. During an observation on 1/8/2026 at 1:30 PM, the DON approached CNA 2, and CNA 2 went to Resident 4's room and asked Resident 4 what the resident needed. Resident 4 stated the resident needed to have a bowel movement. CNA 2 stated the CNA would help the resident and asked resident to wait a few minutes. During an observation on 1/8/2026 from 1:30 PM to 1:35 PM, Resident 4 was sitting in a wheelchair and was no longer yelling. During an interview on 1/8/2026 at 1:40 PM, LVN 1 stated that LVN 1 was preoccupied with the medication pass. LVN 1 stated that when a resident would call out to use the bathroom, LVN 1 needed to check on the resident and page the staff assigned to that resident. During an interview on 1/8/2026 at 2:06 PM, CNA 1 stated that at the time CNA 1 went to Resident 4's room, CNA 1 was taking out meal trays. CNA 1 stated that Resident 4 could get very persistent, and that there were not a lot of things that would keep Resident 4 happy. During a review of the facility's Policy and Procedure (P&P), titled (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 3 Event ID: 055344 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 055344 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/08/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Claremont Heights Post Acute 590 S. Indian Hill Blvd. Claremont, CA 91711 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)