Inspection·June 5, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, and facility document review, the facility failed to complete the post fall neuro-checks at the specific time frames as per the facility's 72 hours Neuro-check Monitoring process for one of three sampled residents (Resident 1). This failure had the potential for Resident 1 to experience medical complications which could go unnoticed post fall. Residents Affected - Few Findings: Review of the facility's 72 hours Neuro-check Monitoring showed the neuro-checks must be monitored every 30 min for two times, every hour for three times, every two hours for two times, every four hours for four times, and every eight hours for six times. Medical record review for Resident 1 was conducted on 6/4/24. Resident 1 was admitted to the facility on [DATE], with diagnoses including Parkinson's disease, OPD, lack of coordination, difficulty in walking, cognitive communication deficits, muscle weakness, and osteoarthritis. Review of Resident 1's progress note dated 5/31/24 at 0300 hours, showed Resident 1 fell from his wheelchair and hit his left hip on the floor. Review of Resident 1's neuro-check report dated 5/31/24, showed the neuro-checks were monitored at 0300, 0330, 0630, 0930, and 1230 hours. Further review of the medical record showed the resident was transferred to the acute care hospital on 5/31/24 at 1250 hours. On 6/5/24 at 0840 hours, an interview and concurrent medical record review was conducted with LVN 1. When asked about the facility's protocol after the resident having a fall, LVN 1 stated the nurse would need to assess the resident, do the neuro-checks for 72 hours, and complete the change of condition's fall risk assessment, progress notes, and care plan. LVN 1 verified the neuro-checks for Resident 1 were completed on the following dates and times: - 5/31/24 at 0300 hours - 5/31/24 at 0330 hours - 5/31/24 at 0630 hours - 5/31/24 at 0930 hours (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: 055689 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 055689 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE St. Catherine Healthcare 245 E Wilshire Avenue Fullerton, CA 92832 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)