Health inspection·September 26, 2024

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure medications were properly stored in accordance with facility ' s policies and procedures and standards of practice when one of three residents, Resident 3 was observed to have these medications stored at his bedside unlocked: 1. One opened bottle of Genvoya (used to treat infections). 2. An injection pen of Ozempic (used to treat diabetes). This failure had the potential to place Resident 3 ' s health at risk for drug abuse and ingestion of unsanitary drugs. Findings: During a review of Resident 3 ' s admission Records, the record (contains demographic and medical information), indicated Resident 3 was admitted on [DATE]. With diagnoses that included type 2 diabetes mellitus (a disease of not able to control the blood sugar levels), cirrhosis of liver (a condition of damaged liver) and chronic kidney disease (a condition when the kidneys gradually stop working). During a review of Resident 3 ' s clinical record, History and Physical dated August 7, 2023, indicated, . Assessment: . 7. HIV (human immunodeficiency viruses (a disease that destroys the cells that fight infection in the body) positive Z21 . During an observation and interview on September 11, 2024, at 9:40 AM, with Resident 3, Resident 3 stated, I keep the medicines here with me (Resident 3 reached for a plastic bag lying on his bed took out a bottle of Genvoya and an injection per of Ozempic). He stated, I keep them here (pointing at the bed) with me. During an interview on September 11, 2024, at 9:50 AM, with Licensed Vocational Nurse (LVN 1), the LVN 1 was asked if Resident 3 kept his medications by the bedside. The LVN 1 stated, Yes, he keeps the Ozempic and a bottle of Genvoya medications at the bedside, but it is a nurse that administers the medications to him. During an observation and interview on September 11, 2024, at 9:55 AM, with the Director of Nursing (DON), the DON was asked if Resident 3 kept his medications by the bedside. The DON stated, Yes, we (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: 056024 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 056024 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Palms Healthcare Center 7534 Palm Ave Highland, CA 92346 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)