Inspection·March 11, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure one of three residents (Resident 2) call light remained within reach and accessible for a distressed resident (Resident 2) while in bed. Residents Affected - Few This failure resulted in Resident 2 ' s needs not being met in a timely manner and deprived this mentally compromised resident of assistance when needed. Findings: During a review of Resident 2's clinical record, the face sheet (contains demographic and medical information), indicated Resident 2 was initially admitted on [DATE], with diagnoses which included: Anxiety, Depressive disorder, schizoaffective disorder (mental illness that can affect your thoughts, mood, and behavior) and palliative care (relieving the symptoms of an incurable medical condition using comfort measures). During a concurrent observation and interview with Resident 2, on February 15, 2024, at 12:07 PM, Resident 2 is observed shaking, crying, and wearing a sweatshirt with sweatpants. Resident 2 states, I need to get undressed. I have on my hot clothes. Come here. Resident 2 stated further, My nurse (certified nursing assistant, cna 2) just pushed my table in front of me and left. I can ' t reach my call light. I don ' t know where it is. (Cna 2) did not give me my call light. Can you tell someone to help me? Resident 2 did not locate her call light to call for assistance. During a concurrent observation and interview with a Certified Nursing Assistant (Cna 1) in Resident 2 ' s room, on February 15, 2024, at 12:13 PM, Cna 1 verified the call lights location, on the floor, close to the wall, near the head of the bed. Cna 1 stated, The call light is supposed to be in reach. The call light is not within reach and Resident 2 is not able to use the call light. (Cna 2) was just in here with Resident 2. Cna 1 stated further Resident 2 had a panic attack (sudden episode of intense fear that triggers severe physical reactions). During an interview with Licensed Vocational Nurse (LVN 1), on February 15, 2024, at 12:33 PM, We are to make sure the call lights are in reach, and the residents can use the call light if they need something. It ' s for their safety and to meet their needs. Room rounds are made often to make sure the call lights are in place. Resident 2 gets very anxious and has panic attacks. LVN 1 stated further, Resident 2 ' s call light should have been within reach. During an interview with Director of Nursing (DON), on February 15, 2024, at 2:40 PM, DON stated, The call lights are to be within reach to attend to the resident ' s needs. DON stated further Resident 2 ' s call light should have been within reach. (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: 055557 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 055557 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Creekside Post Acute 35253 Avenue H Yucaipa, CA 92399 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)