Health inspection·August 14, 2025

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide residents and their families with a written Notice of Transfer/Discharge for three of three residents (Resident 1, 2, and 3), when reviewed for discharge. These failures had the potential for residents to experience increased anxiety, when last-minute discharges were conducted, with no ability to appeal the discharge. Findings:An unannounced visit was made to the facility on 8/14/25, in response to a complaint involving a discharge.1. Resident 1 was admitted to the facility on [DATE], with diagnoses which included chronic kidney disease, stage 4, (severe kidney damage with significantly reduced kidney function), per the facility's admission Record.Resident 1 had a Responsible Party (RP-a person designated to make medical and financial decisions on the resident's behalf) listed on the admission RecordOn 8/14/25, Resident 1's clinical record was reviewed.According to the discharge Minimum Data Set, (MDS-a clinical assessment tool), dated 7/25/25, Resident 1 had a cognitive score of 12, indicating cognition was moderately impaired. According to the facility's nursing notes, titled Discharge summary, dated [DATE] at 12:26 P.M., Resident 1 was discharged to an assisted living facility, via medical transport.There was no documented evidence that a written Notice of Transfer/Discharge was provided to the resident or the RP, prior to discharge.2. Resident 2 was admitted to the facility on [DATE], with diagnoses which included cellulitis (an infection of the skin and subcutaneous tissue), per the facility's admission Record.On 8/14/25, Resident 2's clinical record was reviewed.According to Resident 2's discharge MDS, dated [DATE], a cognitive score of 13 was listed, indicating cognition was intact.The facility's Discharge Planning Review Form, dated 7/11/25, indicated Resident 2 was being discharged to an Independent Living Facility, for a lower level of care.There was no documented evidence that a written Notice of Transfer/Discharge was provided to the resident, prior to discharge.3. Resident 3 was admitted to the facility on [DATE], with diagnoses which included pneumonia (Infection in the lungs), per the facility's admission Record.On 8/14/25, Resident 3's clinical record was reviewed.According to Resident 3's discharge MDS, dated [DATE], a cognitive score of 14 was listed, indicating cognition was intact.The facility's Discharge Planning Review Form, dated 7/18/25, indicated Resident 3 was being discharged to an Assisted Living Facility, for a lower level of care.There was no documented evidence that a written Notice of Transfer/Discharge was provided to the resident, prior to discharge.An interview and record review was conducted with the Director of Nursing (DON) on 8/14/25 at 10:28 A.M. The DON stated Notices of Transfer/Discharge should be provided in writing to residents within 30 days of discharge. The DON stated that a copy of the signed Notice was placed in the medical record. The DON reviewed Resident 1,2, and 3's medical record and could not locate any documentation that a Notice of Transfer/Discharge was provided. The DON stated providing a Notice of Transfer/Discharge was important, so residents and their families knew what was occurring and that preparations were being made in advance. The DON stated the Notice also helped prepare the residents 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 3 Event ID: 055685 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 055685 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Place Spring Valley 9009 Campo Road Spring Valley, CA 91977 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)