Health inspection·January 30, 2024

F 0685 Assist a resident in gaining access to vision and hearing services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and medical record review, the facility failed to arrange for the transportation to and from ophthalmology appointments for one of two sampled residents (Resident 1). This posed the risk of the resident not receiving the necessary vision related care and treatment. Residents Affected - Few Findings: On 1/30/24 at 0922 hours, a telephone interview was conducted with Family Member 1. Family Member 1 stated Resident 1 missed her ophthalmology appointments in December 2023 and January 2024 because the facility did not arrange for the transportation. Family Member 1 stated the ophthalmology appointments were crucial as Resident 1 had diabetes and glaucoma and needed to have her eyes examined and eye pressure checked. Medical record review for Resident 1 was initiated on 1/30/24. Resident 1 was admitted to the facility on [DATE]. Review of Resident 1's History and Physical Note dated 8/11/23, showed Resident 1's diagnoses included diabetes and glaucoma. Review of Resident 1's Physician Order dated 6/15/23, showed Resident 1 had a follow-up ophthalmology appointment on 12/15/23 at 1010 hours. Review of Resident 1's Progress Notes dated 12/15/23 at 1449 hours, showed the transportation company could not take Resident 1 to her scheduled ophthalmology appointment as it was in a different county and the appointment had to be rescheduled. Review of Resident 1's Physician Order dated 12/18/23, showed Resident 1's rescheduled ophthalmology appointment was on 1/19/24 at 1030 hours. Review of Resident 1's Progress Notes dated 12/15/23 to 1/18/24, did not show the arranged transportation for Resident 1's ophthalmology appointment scheduled on 1/19/24 at 1030 hours. Review of Resident 1's Progress Notes dated 1/19/24 at 1037 hours, showed the transportation company could not take Resident 1 to her scheduled ophthalmology appointment on 1/19/24 at 1030 hours, as there was no availability. On 1/30/24 at 1142 hours, an interview and concurrent medical record review was conducted with the Director of Social Services. The Director of Social Services verified the above findings. The (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: 055983 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 055983 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Coventry Court Health Center 2040 S. Euclid Avenue Anaheim, CA 92802 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)