Health inspection·June 20, 2025

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 observation, interview and record review, the facility failed to ensure one of three sampled residents (Resident 1) received treatment for a left first toe fracture (break in bone) per physician's orders. Residents Affected - Few This deficiency had the potential for Resident 1's injury to get worse. Findings: During a review of Resident 1's admission Record (AR), the AR indicated Resident 1 was admitted to the facility on [DATE] with multiple diagnoses including disorders of bone density and structure (condition where bones become weaker and more prone to fracture) and muscle wasting and atrophy (the loss of muscle mass and strength resulting in reduced physical function and mobility). During a review of Resident 1's Minimum Data Set (MDS - a federally mandated resident assessment tool) dated 5/2/2025, the MDS indicated Resident 1 had moderately impaired cognition (ability to understand and process information) and required partial assistance (helper does less than half the effort) for personal hygiene and to walk 10 feet. During a review of Resident 1's Radiology Results Report (RRR) dated 6/6/2025, the RRR of Resident 1's left foot x-ray (test that captures images of the structures inside the body) indicated had a finding of diffuse osteopenia (condition where bone mineral density is lower than normal), with an acute fracture present at the base of the left first toe without significant displacement. During a review of Resident 1's Interdisciplinary Team Conference Record (IDTR) dated 6/9/2025, the IDTR indicated a Certified Nurse Assistant (CNA) noticed a bruise on Resident 1's left first toe and at the base of the left second toe without known cause or complaints of pain from Resident 1. The IDTR further indicated an x-ray was completed and resulted with an acute fracture of the left first toe and diffuse osteopenia. The IDTR indicated Resident 1's physician was made aware and instructed to tape the first toe to the second toe and an appointment for orthopedic (branch of medicine that deals with the musculoskeletal system) consult was scheduled for 6/13/2025 at 3:30 PM. During a review of Resident 1's Order Summary Reported (OSR) with active orders as of 6/20/2025, the OSR indicated to tape the first toe to the second toe until orthopedic consult was done. During a review of Resident 1's Progress Notes (PN) dated 6/18/2025, the PN indicated the facility received Resident 1's after visit progress note from Resident 1's orthopedic appointment scheduled 6/13/2025. The PN indicated the orthopedics' recommendation to buddy tape (the practice of bandaging an injured finger or toe to an uninjured one) or splint (medical device used to support and protect (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: 056083 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 056083 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/20/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woods Health Services 2600 A Street LA Verne, CA 91750 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)