Health inspection·June 27, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, interview, and record review, the facility failed to provide adequate supervision to prevent accidents while smoking for one of four sampled residents (Resident 2). Residents Affected - Few This failure had the potential for residents to suffer significant injuries. During an observation on 5/30/25 at 8:35 a.m. while walking up to the front entrance of the facility, Resident 2 was observed lying in the street after sustaining a fall from his wheelchair after going off the curb of the sidewalk while alone in the front of the facility to smoke a cigarette. The surveyor walked into the facility to look for staff to get assistance but was unable to locate any staff members. The surveyor walked down the hall to the nurse's station and alerted Charge Nurse (CN) of Resident 2 lying in the street next to his wheelchair. Observed multiple staff running out of the facility to assist the resident back into his wheelchair and assess Resident 2 for injuries. Followed staff outside to the front of the facility to observe. Resident 2 was yelling at staff to leave him alone and not to call an ambulance as Resident 2 stated, I am not going to the hospital. Resident 2 was found to have 2 packs of cigarettes and a lighter in his possession. During an interview on 5/30/25 at 8:45 a.m. with Resident 2, Resident 2 stated he went out at the front to smoke. Resident 2 stated he keeps his own cigarettes in his room and goes outside to smoke whenever he wants to. Resident 2 stated he does not use the facilities smoking area and does not wear that stupid bib. Resident 2 stated that nobody watches him when he smokes. During a review of Resident 2's Medical Record (MR), the MR indicated, Resident 2 had a past medical history of Alcohol Abuse, Unspecified Dementia, Alcoholic Cirrhosis of the Liver without Ascites (a condition where the liver is scarred due to excessive alcohol consumption, but fluid buildup in the abdomen (ascites) is not present), Bipolar Disorder (mental health condition characterized by extreme shifts in mood, energy, and activity levels), Chronic Obstructive Pulmonary Disease (COPD- a group of lung diseases that cause long-term breathing problems), Malignant Neoplasm of Prostate with urinary catheter for bladder obstruction, absence of right great toe and other right toes, and difficulty in ambulation (walking). Resident 2 had a BIMS score of 8 (Brief Interview for Mental Status. The BIMS test is used to get a quick snapshot of how well a person is functioning cognitively at the moment. Score of 8 to 12 indicates Moderate cognitive impairment). During a concurrent interview and record review on 5/30/25 at 10:10 a.m. with Director of Nurses (DON), DON stated Resident 2 fell on 5/28/25 without sustaining any injuries. DON stated the fall was similar to the one this morning [5/30/25] where Resident 2 went out in front of the facility to smoke and fell out of his wheelchair. The DON stated the smoking assessment is done at time of admission and indicated that Resident 2 should be supervised when he smokes. Review of Interdisciplinary Team (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: 055861 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 055861 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ojai Health & Rehabilitation 601 North Montgomery Street Ojai, CA 93023 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)