Health inspection·October 8, 2024

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to readmit one of one sampled resident (Resident 1) from General Acute Care Hospital (GACH) 1 after Resident 1 was cleared by GACH 1 to return to the facility on [DATE]. This deficient practice had the potential to result in the denial of Resident 1's rights to return to the facility. Findings: During a review of Resident 1's admission Record (AR), the AR indicated Resident 1 was admitted to facility on 9/5/2024, with diagnoses including respiratory failure (when the lungs cannot get enough oxygen into the blood), quadriplegia (the condition in which both the arms and legs are paralyzed [unable to move]), and type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar). During a review of Resident 1's Minimum Data Set (MDS - a federally mandated resident assessment tool), dated 9/25/2024, the MDS indicated the resident had severely impaired (never/rarely made decisions) cognitive skills (ability to make daily decisions). Resident 1 was dependent (helper does all the effort) on staff for dressing, personal hygiene, and toilet use. During an interview on 10/8/2024 at 9:46 a.m. with the Administrator (ADM), the ADM stated Resident 1 was admitted to the facility on [DATE]. The ADM stated the resident had Medi-Cal (a public health insurance program). The ADM stated Resident 1 was sent to GACH 1 on 9/26/2024. The ADM stated when Resident was ready to be discharged from GACH 1 and return to the facility (on 10/2/2024), Resident 1 was no longer eligible for Medi-Cal. During a telephone interview on 10/8/2024 at 10:08 a.m. with the GACH 1's Social Worker (GACH 1 SW), the GACH 1 SW stated Resident 1 was admitted to GACH 1 on 9/25/2024. The GACH 1 SW stated Resident 1 was ready to return to the facility on [DATE]. The GACH 1 SW stated the facility informed GACH 1 the facility could not accept Resident 1 back to the facility until Resident 1's Medi-Cal was active again. The GACH 1 SW stated Resident 1's Medi-Cal eligibility was not showing up on the Medi-Cal system that Resident 1 was eligible for Medi-Cal. The GACH 1 SW stated GACH 1 had received a verbal confirmation from Medi-Cal that Resident 1 was eligible. The GACH 1 SW stated the facility was provided the new and active Medi-Cal number for Resident 1. During an interview on 10/8/2024 at 10:28 a.m. with the facility's Admissions Coordinator (AC), the AC stated on 10/1/2024, someone (the AC could not remember who she spoke with) from GACH 1 called (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: 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 10/08/2024 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)