Inspection·September 12, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to follow the physician's order to monitor the whereabouts for one of six sampled residents (Resident 5). This failure had the potential to result in accident hazards and safety concerns for Resident 5. Findings: During an observation on September 5, 2023, at 10:30 AM, Resident 5 was observed to be in the dining room, sitting on a chair, at the table with other residents. During a review of Resident 5's admission Record, (contains demographic and medical information), the admission Record indicated, Resident 5 was admitted to the facility on [DATE], with diagnoses which included Alzheimer's disease ( brain disorder that slowly destroys memory and thinking skills), schizoaffective disorder (a mental illness that can affect your thoughts, mood and behavior), and bipolar disorder (a mental illness that causes unusual shifts in a person's mood, energy, activity levels, and concentration). During a concurrent interview and record review on September 5, 2023, at 12:22 PM, with the Director of Nursing (DON), the DON reviewed Resident 5's Physician's Order, dated March 14, 2023, which indicated, Monitor for whereabouts Q (every) 2 H (hours) During further interview and record review on September 5, 2023, at 12:23 PM, with the DON, the DON reviewed Resident 5's, Medication Administration Record, (MAR- a report detailing the administered care provided to the resident by the healthcare professional), for the month of August 2023, and acknowledged there were no documentation to indicate Resident 5 was monitored for her whereabouts for the following dates and times: i. August 14, 2023, at 6:00 AM. ii. August 16, 2023, at 6:00 AM. During a concurrent interview and record review on September 5, 2023, at 12:24 PM, with the DON and the Administrator, the facility's policy and procedure (P&P) titled, Safety and Supervision of Resident, dated July 2017, was reviewed. The P&P indicated, Our facility strives to make the environment as free from accident hazards as possible. Resident safety and supervision and assistance to prevent accidents are facility-wide priorities .4. Implementing interventions to reduce accident risks and (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: 055650 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 055650 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Care Center of Redlands 700 E Highland Ave Redlands, CA 92374 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)