Inspection·December 18, 2023

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few around 2415 and notified admission administrator Officer and talked to them. Case number with police captain and other officer. Resident family asked medications needed and lend to the police officer. 6. Facility could NOT Provide Progress Note of transfer to acute hospital due to behaviors, No documentation from staff informing acute hospital upon transfer they will not be taking resident back, No documentation of family and ombudsman notification of transfer with no plan of readmission and No 7 day Bed hold on last date transfer December 05, 2023. During an interview with the Registered Nurse Supervisor (RN1) on December 18, 2023, at 10:01 AM, the (RN1) stated, On December 05, 2023 (Resident 1) was sent out 5150, that day there was incidents he was going to other residents ' rooms, and he started to get more aggressive. We called police and ambulance, they took him to acute hospital, for his behavior. We called them and they said take him to emergency room (ER) first instead of the behavior unit. His behaviors with residents and staff we couldn ' t handle this resident. The hospital released him. There is just physician order documentation of resident being sent out on the 5150. He was endangering the other patients, which is why we sent him out, that ' s the reason why he couldn ' t be let back in. He was on one on one for about a month, then he exhibits his behaviors again, we couldn ' t control his behaviors, he cannot sit, constantly walking around, he is very strong, and we count control his behaviors here. During an interview with the Social Worker (SW) on December 18, 2023, at 10:39 AM, the (SW) stated, That day I got a call transferred to me from the acute hospital, the nurse stated they were sending him back, I told her I was not made aware he was coming back, I told her we were not receiving him back. I placed her on hold and endorse to my charge nurse (RN1). When I came back to the call the hospital nurse had hung up. We did an Interdisciplinary meeting (IDT) with his family member due to his behaviors and reaching out to facilities to help accommodate and find an appropriate facility for his aggressive behaviors. I did not document the conversation with the acute hospital. During an interview with the (RN2) on December 18, 2023, at 11:08 AM, the (RN2) stated, (Resident 1) was already sent out when I arrived on shift. I was here when he came back, I was given instructions not to take the resident back .he arrived around 1147, the admission Director called me not take resident back, due to him needed to be evaluated by hospital for 72 hours, the patient is not appropriate for this facility. When asked, should he have been let back in? No, because I was told not to and following the instructions. I ' m the RN, we take into consideration the safety of the other residents. During an interview with the admission Coordinator (AC) on December 18, 2023, at 11:15 AM, the (AC) stated, Resident 1 was sent to another acute hospital after we didn ' t take him back. Usually his insurance has a 7-day bed hold. The nurses will follow up with the 7 days behold. I explained to the acute hospital case manager what happened that day and she was unaware of what had happened. And understood why we did not readmit him back. During an interview with the Marketing Director (M.D) on December 18, 2023, at 11:36 AM, the (MD) stated, I called the acute hospital ER department to see if Resident 1 was still there, spoke with the nurse briefly about what happened in facility, and we were not able admit him back. I spoke with her twice, we were not able to take him back, she told me he was a well-known resident, and they couldn ' t hold him for the 5150 due to his dementia. Even after 2 conversations with the nurse they still send him back. Our nurse called me that night, we called the Police around midnight or 1 am, I told him the incident. The hospital did not call us for report. I told the Police we are not going to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055650 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 055650 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2023 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)

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few readmit this resident, and we told them we are not accepting due aggressive behaviors, we didn ' t accept him and they took him to another acute hospital. During an interview with the Administrator (Admin) on December 18, 2023, the (Admin) stated, We had been talking with the family about his behaviors we had one on one for Resident 1, we sent him out with the Police and the ambulance. We had multiple calls with the family member, we could not accommodate this resident. Our Marketing Director called the hospital and notified them we were not able to take this resident back due to behaviors and our residents had concerns of safety. Our (SW) spoke with the nurse from the hospital he was sent to and tell them we are not taking this resident back. On December 06, 2023, at 12:29AM I got a text from staff, we had advised our nurses not to take the resident back because of the behaviors. The hospital did not even call us to give report, before they sent him back. When asked, should Resident 1 should have gotten a 7-day behold? Replied, I don ' t think he got a behold, there is no document of 7-day bed hold. There was no 7-day bed hold. When asked, should he have been readmitted because he was your resident? Reply, No, because he was a danger to other residents and our staff. During a review of the facility ' s policy and procedure titled, Transfer or Discharge, Facility Initiated revised (October 2022), the policy and procedure indicated, Policy Statement: Once admitted to the facility, residents have the right to remain in the facility. Facility-initiated transfers and discharges, when necessary, must meet specific criteria and require resident/representative notification and orientation, and documentation as specified in this policy. Notice of Transfer or Discharge (Planned) 1. Except as specified below, the resident and his or her representative are given a thirty (30)-day advance written notice of an impending transfer or discharge from this facility .Notice of Transfer or Discharge (Emergent or Therapeutic leave) 1. When resident who are sent emergently to an acute setting, these scenarios are considered facility-initialed transfers, NOT discharges, because the residents return is generally expected .4. Notice of Transfer is provided to the resident and representative as soon as practicable before the transfer and to the long-term care (LTC) ombudsman when practicable (e.g. in a monthly list of residents that include all notice content requirements). 5. Notice of Facility Bed Hold and Return policies are provided to the resident and representative within 24 hours of emergency transfer . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055650 If continuation sheet Page 3 of 3