Health inspection·January 16, 2026

F 0756 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to follow its Policy and Protocol (P&P) for 1 of 18 sampled residents (Resident 18) by not ensuring physician review and documented response to the consultant pharmacist's Medication Regimen Review (MRR - a comprehensive, mandatory evaluation of a resident's medication regimen performed by a licensed pharmacist to promote positive outcomes, minimize adverse consequences, and ensure safety) for lorazepam (anti-anxiety medication) regimen when:This failure had the potential to result in Resident 18's continued use of an unnecessary drug (a medication given without a clear ongoing need or proper monitoring and/or adverse medication-related outcomes (harmful side effects)) without appropriate physician oversight and clinical rationale (a documented medical reason for the decision).During a review of Resident 18's admission Record (AR), the AR indicated, Resident 18 is a [AGE] year-old female admitted to the facility on [DATE] with diagnoses including: Anxiety (ongoing excessive worry or nervousness), depression (persistent low mood that affects daily functioning), Pulmonary hypertension (high blood pressure in the blood vessels of the lungs), Cerebral tissue perfusion impairment (reduced blood flow to the brain), and stroke/hemorrhagic (a brain injury caused by bleeding in the brain). During a concurrent interview and record review on 1/15/26 at 3 p.m. with the Minimum Data Set (MDS) nurse, Resident 18's Pharmacist Review of Patient's Drug Regimen (a pharmacist's monthly medication review form) was reviewed and indicated:On 1/31/25 the pharmacist documented, Will ask for GDR on Lorazepam in February. The document was signed by the pharmacist and the Director of Nursing (DON) on 1/31/25.On 2/26/25 the pharmacist documented, Lorazepam 0.5 mg, PO (by mouth), q 6H (every 6 hours), PRN (as needed) anxiety. May we reduce (GDR - a planned decrease in medication dose over time to see if the resident still needs it) Lorazepam? The pharmacist further documented, No response, re-submitting request in March. The document was signed by the pharmacist and the DON on 2/26/25.On 3/27/25 the pharmacist documented, Resubmitting GDR attempt for Lorazepam. The document was signed by the pharmacist and the DON on 3/2725. The MDS nurse was unable to locate documentation in Resident 18's medical record showing physician review and response to the pharmacist's MRR for lorazepam, no physician response, physician acknowledgement, or documented physician decision (to reduce, discontinue, or continue the medication with clinical rationale) was located in the resident's medical record for the above MRR recommendations.During an interview on 1/15/26 at 3:30 p.m. with the DON, the DON acknowledged the facility did not follow up with the physician to ensure the physician reviewed and responded to the pharmacist's MRR recommendations regarding Resident 18's lorazepam regimen. The DON further acknowledged the resident's medical record did not reflect physician documentation addressing the pharmacist's recommendation.During a review of the facility's policy and procedure (P&P) titled, Skilled Nursing Facility Medication Regimen Review, last revised 10/2023, the P&P indicated, The pharmacist provides consultation to the facility and attending physician regarding the medication regimen . Reports of non-urgent irregularities must be acted upon prior to the pharmacist's next monthly review and/or more promptly if there is no action or response, or only an incomplete response to an irregularity . the pharmacist will attempt to contact the physician or nursing staff to obtain a response. If no response is obtained within 5 business days, the facility and pharmacist should contact the facility's medical director for guidance and possible intervention to resolve the issue. Event ID: Facility ID: 056200 If continuation sheet Page 2 of 3 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 056200 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/16/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Community Memorial Continuing Care Center 1306 Maricopa Highway Ojai, CA 93023 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)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review the facility failed to ensure food items stored in the refrigerators were clearly labeled and dated to support safe storage practices when:Multiple perishable food items had unclear or incomplete date stamps, preventing staff from determining the appropriate use-by/discard timeframe.A perishable sandwich containing meat and cheese was stored without a label identifying the contents/type of the sandwich. These failures had the potential for residents to consume expired or contaminated food and increase the risk of allergen exposure due to unidentified ingredients, placing residents at risk for foodborne illness and allergic reactions.During an observation and concurrent interview on 1/13/25 at 9:37 a.m. with the Director of Food and Nutrition Services (DFNS) in the facility kitchen's walk-in refrigerator, the following food items were observed, diced watermelon in a 2-ounce (oz) clear plastic container with lid, sour cream in a 2-oz clear plastic container with lid, a brownie on a plate covered with a clear plastic food wrap, and whipped cream in a sealed, cone-shaped manufacturer bag had labels that were not legible. The DFNS confirmed that multiple perishable food items had date markings that were not clearly legible due to poor ink/printing with missing components of the date. The RD stated, ‘The labels need to be re-printed to clearly show all parts of the date.'During an observation and concurrent interview on 1/14/25 at 10:53 a.m. with the DFNS in the facility kitchen's Dining Room Refrigerator, a sandwich in a clear food wrap was missing the label with product/sandwich name and ingredients list. DFNS confirmed the sandwich wrapped in a clear food wrap was missing the label with product/sandwich name and ingredients list. The DFNS stated, ‘There should have been an orange label on top of the clear food wrap with the name of the sandwich and ingredients list, and needs to removed immediately.During a review of the facility policy and procedure (P&P) titled ‘Food and Supply Storage,' last revised 04/2025, the P&P indicated, Use the Medvantage/Freshdate labeling system or complete all sections on a [NAME] orange label. Cover, label and date unused portions of open packages. Event ID: Facility ID: 056200 If continuation sheet Page 3 of 3