Health inspection·May 29, 2024

F 0623 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide a notice of proposed discharge to one of three residents, Resident 2, when Resident 2 was discharged from the facility after being transferred to the general acute care hospital (GACH). In addition, the facility failed to notify the Long-Term Care (LTC) Ombudsman (an advocate for residents and families in long-term care facilities) and Resident 2's family member (FM) of Resident 2 ' s discharge from the facility. This failure placed Resident 2 at an increased risk of being discharged without having an advocate to ensure a safe and effective transition of care, or without having a clear understanding of his appeal and discharge rights. Findings: A review of Resident 2 ' s medical record was conducted on April 29, 2024. Resident 2 was admitted to the facility on [DATE], with diagnoses which included cerebral infarction (damage to tissues in the brain due to loss of oxygen to the area), hypertension (high blood pressure), depression (mood disorder that causes a persistent feeling of sadness and loss of interest), schizoaffective disorder (a mental health disorder), and convulsions (the condition of uncontrollable shaking of the body). Resident 2's Change of Condition Progress Notes, dated, March 27, 2024, at 9:10 p.m., indicated Resident 2 was transferred to the GACH due to being unresponsive. On April 29, 2024, at 3:23 p.m., an interview was conducted with the Admissions Director (AD). The AD stated Resident 2 was at the hospital and that Resident 2 had been medically cleared to return to the facility on April 18, 2024. The AD stated Resident 2 was not allowed back to the facility because he required isolation and there was no isolation bed available. On May 1, 2024, at 12:45 p. m., a record review with the Administrator (ADM) of Resident 2 ' s medical record was conducted. The ADM verified Resident 2's bed hold ended April 3, 2024, and that the facility initiated Resident 2's discharge on [DATE]. The ADM was unable to provide Resident 2's discharge notification documents from the facility. There were no notes or documents noted in PCC (computer application for documentation) that the facility informed Resident 2, Resident 2's FM, or the LTC Ombudsman of Resident 2's discharge from the facility on April 3, 2024. On May 1, 2024, at 12:55 p.m., in an interview with the Social Services Director (SSD), the SSD stated the facility initiated Resident 2 ' s discharge from the facility on April 3, 2024, and there was no documentation Resident 2 ' s FM or that the LTC Ombudsman was notified Resident 2 would not be (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 4 Event ID: 055409 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 055409 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Community Care and Rehabilitation Center 4070 Jurupa Avenue Riverside, CA 92506 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)