Inspection visit
Health inspection
1 citation recorded
Inspector’s narrative
What the inspector wrote
This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited
to receiving treatment and supports for daily living safely.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and record review, the facility failed to ensure three of five sampled residents
(Residents 4, 5, and 6) had a comfortable and homelike environment for three days when the facility failed
to ensure the air temperatures were safe and comfortable in nine of 20 resident rooms, according to the
facility's policy and procedure (P&P) titled, Homelike Environment, revised February 2021.
This failure resulted in Residents 4, 5, and 6 being uncomfortable and had the potential to negatively affect
residents' (in general) health and well-being.
Findings:
a. During a review of Resident 4's admission Record (AR) the admission record indicated Resident 4 was
admitted to the facility on [DATE] with diagnoses that included multiple sclerosis (MS, a chronic disease that
affects the brain and spinal cord), quadriplegia (the condition in which both the arms and legs are
paralyzed), and congestive heart failure (condition in which the heart cannot pump enough blood to all
parts of the body).
During a review of Resident 4's Minimum Data Set (MDS, a standardized assessment and care screening
tool), dated 6/27/2024, the MDS indicated Resident 4 had no impairment in cognitive skills (the ability to
make daily decisions). The MDS indicated Resident 4 was dependent on staff for toileting, dressing, and
bathing.
b. During a review of Resident 5's admission record, the admission record indicated Resident 5 was
admitted to the facility on [DATE] with diagnoses that included acute respiratory failure (when the lungs
can't get enough oxygen into the blood), chronic kidney disease (a condition in which the kidneys are
damaged and cannot filter blood as well as they should), and insomnia (persistent problems falling and
staying asleep).
During a review of Resident 5's MDS, dated 6/12/2024, the MDS indicated Resident 5 had no impairment in
cognitive skills (the ability to make daily decisions). The MDS indicated Resident 5 was dependent on staff
for toileting and bathing.
c. During a review of Resident 6's admission record, the admission record indicated Resident 6 was
admitted to the facility on [DATE] with diagnoses that included type 2 diabetes mellitus (a chronic condition
that affects the way the body processes blood sugar), infection of amputation stump (after an amputation,
the bit that's left beyond a healthy joint), and cerebral infarction (also called ischemic stroke, occurs as a
result of disrupted blood flow to the brain).
(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:
055449
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
055449
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Covina Rehabilitation Center
261 W. Badillo Street
Covina, CA 91723
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)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
During a review of Resident 6's MDS, dated 8/7/2024, the MDS indicated Resident 6 had no impairment in
cognitive skills (the ability to make daily decisions). The MDS indicated Resident 6 required assistance from
staff for toileting, bathing, and dressing.
During an interview on 9/9/2024 at 2:18 p.m. with the Maintenance Supervisor (MS), the MS stated on
Friday (9/6/2024), one of the Air Conditioner (AC) unit motors burned up (AC unit not working). The MS
stated the AC technician arrived the same day to repair the AC unit. The MS stated rooms in Station 3 were
the hottest rooms in the facility. The MS stated some of the facility staff complained about the air
temperature being too hot in the facility.
During a concurrent observation and interview on 9/9/2024 at 3:09 p.m. with the MS and Resident 4 in
Room A, the MS used an infrared temperature gun (Temp-gun, device that measures temperatures) to
measure the air temperature of Room A. The Temp-gun indicated the room temperature was 89 degrees
Fahrenheit (F, unit of measurement). Resident 4 stated the room was too hot. Resident 4 stated Resident 4
had multiple sclerosis. Resident 4 stated hot temperatures could make Resident 4's MS flare up (also
known as a relapse, when a person with MS experiences new or worsening symptoms).
During a concurrent observation and interview on 9/9/2024 at 3:18 p.m. with the MS on the facility's roof, all
21 AC units were observed. The fan was not turning on the AC unit labeled 307-315. The MS stated the AC
unit should be turning. The MS stated the AC unit was not working correctly. All other AC units on the roof
had their fans running.
During an interview on 9/9/2024 at 3:28 p.m. with the MS, the MS stated the facility had called the AC
Technician (ACT) and that the ACT was on his way to the facility. The MS stated the MS thought another AC
unit motor was broken.
During a concurrent observation and interview on 9/9/2024 at 4:03 p.m. with the MS, all residents' (in
general) room temperatures in Station 3 were checked. The MS used a Temp-gun to check the room
temperatures. The Temp-gun indicated nine of the 20 rooms on the unit had temperatures higher than 81F.
The temperatures of the nine rooms ranged from 83F - 89F.
During a concurrent observation and interview on 9/9/2024 at 4:22 p.m. with the MS and Resident 5 in
room B, the MS used a Temp-gun to measure the air temperature of Room B. The Temp-gun indicated the
room temperature was 89 F. Resident 5 stated it had been hot at the facility for three days. Resident 5
stated Resident 5 felt weak on the previous day (9/8/2024). Resident 5 stated Resident 5 felt weak because
of the heat. Resident 5 stated he wanted to stay in bed and keep his clothes off because it was too hot to
get dressed. Resident 5 stated on Saturday (9/7/2024) Resident 5 wanted to paint but stayed in bed with
his clothes off.
During a concurrent observation and interview on 9/9/2024 at 4:25 p.m. with the MS and Resident 6 in
room C, the MS used a Temp-gun to measure the air temperature of Room C. The Temp-gun indicated the
room temperature was 84 F. Resident 6 stated Resident 6 felt warm. Resident 6 stated he felt
uncomfortable. Resident 6 stated sometimes Resident 6 was sweaty due to the warm temperature in the
facility.
During an interview with ACT on 9/9/2024 at 4:55 p.m. with the ACT, the ACT stated he was at the facility to
fix a different AC unit than the one the ACT fixed on Friday.
During a review of the facility's revised P&P titled, Homelike Environment, revised February 2021,
(continued on next page)
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055449
If continuation sheet
Page 2 of 3
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
055449
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
09/10/2024
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Covina Rehabilitation Center
261 W. Badillo Street
Covina, CA 91723
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)
F 0584
Level of Harm - Minimal harm
or potential for actual harm
the P&P indicated, Residents are provided with a safe, clean, comfortable and homelike environment . The
P&P indicated, The facility staff and management maximizes, to the extent possible, the characteristics of
the facility that reflect a personalized, homelike setting. These characteristics include . comfortable and safe
temperatures of (71 °F - 8 I °F) .
Residents Affected - Some
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
055449
If continuation sheet
Page 3 of 3
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Back to topCitations
1 citation recorded*CMS
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
F584 - Safe Environment
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
FAQ · About this visit
Common questions about this visit
What happened during the September 10, 2024 survey of COVINA REHABILITATION CENTER?
This was a inspection survey of COVINA REHABILITATION CENTER on September 10, 2024. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at COVINA REHABILITATION CENTER on September 10, 2024?
Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receivin..."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.