Inspection·June 18, 2025

F 0689 ventilator, and epilepsy (A brain disorder that causes seizures). Level of Harm - Minimal harm or potential for actual harm Further review indicated, the resident was discharged from the facility on May 21, 2025, and re-admitted to the facility on [DATE]. Residents Affected - Few A review of Resident 2's, Progress Notes, dated, June 2, 2025, at 3:47 a.m., edited at, 5:52 a.m., by Respiratory Therapist (RT), indicated, . (Resident 2) was found fallen out of bed onto face . Alerted all nearby staff . placed pillow under head as 911 was called. Gave report to (911) . hand off (of Resident 2) to (Emergency Medical Staff) . Further review of Resident 2's, Progress Notes, dated, June 2, 2025, at 5:46 a.m., by Registered Nurse (RN) 2, indicated, . RT heard loud thud . (RT) found (Resident 2) lying on right side next to bed on the floor. (RT) alerted staff and we assessed (resident), (resident) had a red right knee. (Resident 2) was still alert and appeared to have no change in mental status . (Resident in stable condition) . 911 was called at (4:50 a.m.). (Emergency Medical Staff) & (Fire Department) arrived at 4:58 (a.m.) . (Resident 2) was transferred to General Acute Care Hospital {GACH} at 05:07 (a.m.) . On June 17, 2025, at 2:55 p.m., an interview was conducted with Registered Nurse (RN) 1, who stated, residents with a history of seizures and required total care (total dependence on nursing staff for all care) have siderails for safety to help prevent falls out of bed. RN 1 stated, during the admission process, nursing staff would complete a siderail evaluation, and if the evaluation indicated resident required siderails for safety, the nurse would notify the physician, and upon receiving a physician order for siderails, siderails would be placed on the resident's bed. A review of Resident 2's re-admission progress note, dated, May 24, 2025, at 5:42 p.m., indicated, . re-admitted (Resident 2) at . 5:18 p.m., (May 24, 2025) from (GACH) . A review of Resident 2's Side Rail Evaluation, dated, May 24, 2025, at 10:20 p.m., indicated resident did require the use of siderails as a safety precaution. A review of Resident 2's physician dated, May 24, 2025, at 6:44 p.m., indicated resident had a physician order for, . Quarter side rails up . when in bed to minimize risk . On June 17, 2025, at 3:52 a.m., an interview was conducted with the Unit Manager (UM), who stated her expectations are for staff to keep residents safe. The UM further stated side rails were used to keep residents safe from falling out of bed. On June 17, 2025, at 5:35 p.m., an interview was conducted with Licensed Vocational Nurse (LVN) 1, who stated, she was working on (June 2, 2025), when Resident 2 was found on the floor. LVN stated the RT called out for staff to help, and she went to resident's room, she observed Resident 2 face down on the floor next to her bed, and the bed had no side rails. LVN 1 further stated, she was Resident 2's nurse that night, and she did not see physician orders for side rails. Further review of Resident 2's physician orders, indicated resident's side rail orders were discontinued on May 25, 2025, at 6:22 a.m., and not renewed, prior to Resident 2 falling out of bed on June 2, 2025. On June 18, 2025, at 11:58 a.m., a concurrent interview was conducted with the UM, and record review of Resident 2's side rail physician order. The UM verified Resident 2's physician order for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056229 If continuation sheet Page 2 of 4 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 056229 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Springs Healthcare & Rehabilitation Center 277 S Sunrise Way Palm Springs, CA 92262 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few siderails was discontinued on May 25, 2025, and not renewed prior to resident falling out of bed on June 2, 2025. The UM stated, she was not sure why Resident 2's physician order for side rails was discontinued, but the order should have been renewed, as resident's side rail evaluation from May 24, 2025, indicated Resident 2 needed side rails for safety. The UM further stated, her expectations were for nursing staff to check the resident's previous side rail evaluation, physician orders, and should notify the physician if they think a resident is missing side rails on their bed. On June 18,2025, at 12:55 p.m., a concurrent interview with the Director of Nursing (DON), and record review of Resident 2's Side Rail evaluation completed on May 24, 2025, and physician orders was conducted. The DON verified, resident's Side Rail evaluation indicated, resident did require the use of siderails for Safety precaution. The DON further verified, Resident 2's physician order for side rails was discontinued on May 25, 2025, and not renewed, prior to resident's fall out of bed on June 2, 2025. The DON stated, her expectations were for nursing staff to check the last side rail evaluation to ensure residents have side rails if deemed necessary, make sure side rail physician orders were received following the evaluation, and should implement the side rails. A review of the facility policy and procedure( P & P) titled, Side Rails, undated, indicated, . An example of appropriate, medically necessary side rail use for a non-mobile resident might be protection from falls related to strong involuntary spasms or seizures . Nursing completes Side Rail Evaluation form . Obtain MD order, including diagnosis/medical necessity for use of restraint . A review of the facility P&P titled, Fall Management, undated, indicated, . Purpose: Based on previous evaluations and current data, the staff will identify interventions related to the resident's specific risks and causes to try to reduce the risk of the resident falling and to try to minimize complications from falling . The nursing staff, in conjunction with the attending physician . will seek to identify and document resident risk factors for falls and establish a resident-centered falls prevention plan based on relevant assessment information . The nursing staff, with the input of the attending physician, will implement a resident-centered fall prevention plan to reduce the specific risk factor(s) of falls for each resident at risk or with a history of fall . 2. A review of Resident 1's admission record dated June 19, 2025, indicated the resident was admitted to the facility on [DATE], with diagnoses which included chronic respiratory failure and dependence on a ventilator (a mechanical breathing device to assist with inadequate independent breathing). On June 17, 2025, at 2:55 p.m., during an interview, Registered Nurse (RN) 1 stated, residents with history of seizures and need total care (total dependence on nursing staff for all care) have siderails for safety to help prevent falls from bed. RN 1 stated, during the admission process, nursing staff would complete a siderail evaluation, and if the evaluation indicated resident would require siderails for safety, the nurse would notify the physician. RN 1 stated as soon as a physician order for siderails were obtained, then side rails would be implemented and placed on the resident's bed. A review of Resident 1's, Side Rail evaluation, dated, March 13, 2025, at 2:51 a.m., indicated, .Resident (1) require(s) the use of siderails(s) . A review of Resident 1's physician orders did not indicate an order for a side rail until April 8, 2025. On June 17, 2025, at 3:52 a.m., an interview was conducted with the Unit Manager (UM), who stated her expectations were for staff to keep residents safe. The UM further stated side rails are used to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056229 If continuation sheet Page 3 of 4 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 056229 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Palm Springs Healthcare & Rehabilitation Center 277 S Sunrise Way Palm Springs, CA 92262 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 0689 keep residents safe from falling out of bed. Level of Harm - Minimal harm or potential for actual harm On June 18, 2025, at 11:58 a.m., during a concurrent interview with UM, and record review of Resident 1's siderail evaluation and physician orders. The UM verified, Resident 1's Side Rail evaluation, indicated resident required the use of siderails, and did not have a physician order for side rails, until April 8, 2025. The UM stated the nursing staff should have obtained a physician order for siderails after the siderail evaluation was completed on March 13, 2025. Residents Affected - Few On June 18,2025, at 12:55 p.m., during a concurrent interview with the Director of Nursing (DON), and record review of Resident 1's siderail evaluation and physician order, the DON verified Resident 1 did require the use of siderails. The DON stated the nursing staff were expected to check the last siderails evaluation to ensure residents would have siderails if deemed necessary, and to make sure a physician order was obtained for the siderails and that it was carried. A review of the policy and procedure (P&P) titled, Side Rails, undated, indicated, . An example of appropriate, medically necessary side rail use for a non-mobile resident might be protection from falls related to strong involuntary spasms or seizures . Nursing completes Side Rail Evaluation form . Obtain MD order, including diagnosis/medical necessity for use of restraint . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056229 If continuation sheet Page 4 of 4