Inspection·December 9, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure an allegation of abuse was reported to the State survey agency within two hours for two of five residents, (Residents 2 and 3).This failure had the potential for a delay in the investigations and interventions to prevent further incidents of abuse. Findings:On December 9, 2025, at 10:14 a.m., an unannounced visit to the facility to investigate an allegation of physical abuse. A review of Resident 2's medical record indicated the resident was admitted on [DATE], with diagnoses of dementia, (a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning) and pressure ulcer injury stage 4 (PUI - full thickness tissue loss with exposed bone, tendon, or muscle).A review of Resident 2's History and Physical dated September 22, 2025, indicated resident was not capable of understanding and making decisions.A review of Resident 3's medical record indicated the resident was admitted on [DATE], with diagnoses of chronic obstructive pulmonary disease, (COPD - a chronic inflammatory lung disease that causes obstructed airflow from the lungs), polyneuropathy, (the simultaneous malfunction of many peripheral nerves throughout the body), and depression, (a mood disorder that causes a persistent feeling of sadness and loss of interest).A review of Resident 3's History and Physical dated November 8, 2025, indicated resident had the capacity to make decisions.On December 9, 2025, at 11:52 a.m., during an observation of Resident 2, the resident was lying in bed on his right side, with eyes slightly opened, respirations were even and unlabored. Resident 2 did not respond to verbal questions. On December 9, 2025, at 12:18 p.m., during an interview with the Licensed Vocational Nurse (LVN 1), LVN 1 stated that Resident 2 was occasionally awake and could not be able to get out of bed. LVN 1 stated allegations of abuse should be reported to the Administrator, Director of Nursing within two hours. LVN 1 stated that an allegation of abuse would require keeping residents apart, physician notification, documentation of a change in condition, and care plan updates. On December 9, 2025, at 12:32 p.m., during an interview with Resident 3, Resident 3 stated that back in November 2025, Resident 2 reached toward the television remote and toward his bed, so he flicked Resident 2 on the head. Resident 3 stated there were no witnesses to the event. On December 9, 2025, at 1:01 p.m., during an interview with Licensed Vocational Nurse (LVN 2), LVN 2 stated that if a resident flicked another resident in the head, she would report the incident right away to the Registered Nurse, the abuse coordinator. A review of Resident 3's Progress Notes dated November 23, 2025, at 8 a.m., indicated Resident hit another resident on the head for being too noisy. Client educated on the importance of hitting or coming into contact with another resident. Resident reported he is lucky I didn't kick his ass. Resident again educated. Resident reported he flick the other resident on the head to quiet him.Further review of Resident 3's Progress Notes dated November 23, 2025, indicated no documentation that the alleged incident was reported to the California Department of Public Health (CDPH) within two hours. On December 9, (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: 056162 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 056162 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Extended Care Hospital of Riverside 8171 Magnolia Avenue Riverside, CA 92504 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)