Health inspection·December 5, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure proper care was provided to prevent a blister (a painful swelling on the surface of the skin), for one of three sampled residents (Resident 1). Residents Affected - Few This failure placed a clinically compromised Residents (Resident 1) health and safety at risk, when a facility acquired blister to the right heel (back of the human foot below the ankle) developed while in the facility. Findings: During a review of Residents 1 ' s admission Record (general demographics), the document indicated Resident 1 was admitted to the facility on [DATE], with diagnoses which included type 2 diabetes mellitus (a disease in which there is too much sugar in the blood and the body is not able to control the sugar ), muscle wasting and atrophy (a condition with shrinking and loss of muscle), and depression (a condition with feeling of sadness and hopelessness). During an interview on November 19, 2024, at 8::55 AM, with Resident 1, Resident stated, They told me, I got a blister on my foot. I did not have any wounds on my feet until I got here. During an interview on November 19, 2024, at 10:15 AM, with Wound Treatment Nurse (WTN), WTN stated, She has a wound on her right heel which started as a blister some weeks ago. During an interview on November 19, 2024, at 10:20 AM, with Assistant Director of Nursing (ADON), ADON stated, The blister on her right heel developed after admission but was already there before November 1, 2024. During a phone interview on December 3, 2024, at 10:40 AM, with the ADON, ADON acknowledged that Resident 1 did not have wounds on her heels upon admission [DATE]). ADON stated, A fluid blister was observed on October 30, 2024. Review of following facility records: 1. admission Skin Issues: October 5, 2024, 10:43. Skin warm and dry, skin color within normal limit and turgor (the ability of skin to change shape and return to normal) is normal. Resident does not have an external device. Foot evaluation completed . Skin Issue: # (number) 001 . Lower back . #002: Right shin . 2. Braden Evaluation ([Severe risk total score: less than 9, High risk total score: 10-12, moderate (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: 055872 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 055872 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Citrus Nursing Center 9440 Citrus Ave Fontana, CA 92335 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)