Inspection·April 1, 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 interview and record review, the facility failed to ensure intravenous (IV - fluids/medication given directly into the bloodstream) antibiotic medications was provided according to the physician's orders upon discharge from the General Acute Hospital (GACH), for one of five residents (Resident A). Residents Affected - Few This failure resulted in Resident A not receiving the IV antibiotics as prescribed, and needed to extend the IV medication to address Resident A's infection. Findings: On March 6, 2025, at 10:30 a.m., an unannounced visit was conducted for the investigation of a complaint for quality of care. On March 6, 2025, at 11:15 a.m., a review of Resident A's medical record was conducted. Resident A's admission Record, indicated Resident A was admitted to the facility on [DATE], with diagnoses which included sepsis (a life-threatening blood infection), bacteremia (bacteria in the blood stream), and xenogenic heart valve (a type of tissue from another species - a pig or a cow). A review of Resident A's Extended Care Facility admission Orders and Transfer (Discharge) Summary, dated December 8, 2024, at 1:20 p.m., indicated, .will continue with prolonged IV ampicillin (medication to treat infection) 2 G (gram - a unit of measurement) q (every) 6 (six) hours and IV Ceftriaxone (medication to treat infection) 2 g (gram) q (every)12 hours until 1/11/25 (January 11, 2025) via PICC (peripherally inserted central catheter - a thin flexible tube inserted into a vein in the upper arm and threaded into a larger vein near the heart). Close follow up with infectious disease . A review of Resident A's Physician's Progress Notes, dated December 20, 2024, by [name of physician], indicated, .continue Ampicillin 2G (gram) IV q (every) 4 hrs (hours) .Continue Ceftriaxone 2G (gram) IV q(every)12 hrs (hours)-Continue both for 6 (six) weeks from 11/30/24 (November 30, 2024) . A review of Resident A's Order Summary Report, included the following physician's orders: - .Ampicillin Sodium Injection Solution Reconstituted 1 GM .Use 2 gram intravenously every 6 (six) hours for BACTEREMIA until 1/13/2025 (January 13, 2025) ., date ordered December 8, 2024; - .Ampicillin Sodium Injection Solution Reconstituted 1 GM .Use 2 gram intravenously every 6 (six) hours for BACTEREMIA for 4 (four) days ., date ordered December 9, 2024; - .Ampicillin Sodium Injection Solution Reconstituted 1 GM .Use 2 gram intravenously every 6 (six) (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 3 Event ID: 056214 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 056214 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ramona Rehabilitation and Post Acute Care Center 485 W. Johnston Avenue Hemet, CA 92543 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)