Inspection·February 11, 2026

F 0908 Keep all essential equipment working safely. 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 maintain proper use of Low Air Low (LAL) Mattresses (A specialized air-filled mattress used to treat and prevent the development of pressure ulcers skin damage caused by prolonged pressure to one area of the body), when the resident's LAL pump/air pressure was not maintained at the proper setting for four of 6 residents reviewed (Residents 1, 2, 3 and 4).This failure had the potential to contribute to the development and/or prolonged healing of pressure ulcer's (PUs). Findings: On February 11, 2026, at 1012 a.m., an interview was conducted with Registered Nurse (RN) 1, who stated a facility medical intervention to help residents avoid development and assist with healing of PU's includes the use of an LAL mattress. The RN stated the LAL mattress has a pump that fills it with air, which relieves prolonged pressure on the resident's skin. The RN further stated the amount of air/pressure of the LAL mattress is controlled by a dial on the pump which is set according to the resident's weight. RN 1 further stated the Subacute Unit's Coordinator (SAC) placed a yellow arrow on each resident's LAL pump, correlating with the resident's weight, indicating to staff where the dial should be set. On February 11, 2026, at 10:35 a.m., a concurrent observation of Resident 1's LAL pump and an interview with RN 1 was conducted. Resident 1's LAL pump had a yellow arrow placed between the numbers of 80 to 160 pounds (lbs.). The resident's LAL dial was set at 400 lbs. RN 1 verified the LAL pump was incorrectly set at 400 lbs., stating it should be set here, as RN turned the pump dial to line up with the yellow arrow between 80 to 160 lbs. A record review of Resident 1's weight, dated January 12, 2026, indicated the resident weighed 117 lbs. On February 11, 2026, at 10:40 a.m., an interview was conducted with the SAC. The SAC stated she placed yellow arrows on the resident's LAL pumps, indicating where staff should set the pump/air pressure, according to the resident's weight. The SAC stated it's important that the resident's LAL pump is set and customized according to the resident's weight because it relieves pressure on the resident's skin and minimizes the risk of developing PU's. On February 11, 2026, at 10:45 a.m., a concurrent observation of Resident 2's LAL pump, and interview with SAC was conducted. Resident 2's LAL pump had a yellow arrow placed between 100 and 150 lbs., and the dial was set at 350 lbs., stating Firm. The SAC stated, The (LAL pumps) dial is not set where it should be. The SAC verified Resident 2's LAL pump was set at 350 lbs., and the correct setting is between 100 and 150 lbs., correlating with Resident 2's weight. A record review of Resident 2's weight, dated January 12, 2026, indicated the resident weighed 144 lbs. On February 11, 2026, at 11:00 a.m., a concurrent observation of Resident 3's LAL pump, and an interview with the SAC was conducted. Resident 3's LAL pump had a yellow arrow placed between 80 to 160 lbs., and the resident's dial was set to 400 lbs., stating Max. The SAC verified Resident 3's pump was not set correctly, stating the dial should be lined up with the yellow arrow between 80 to 160 lbs., not at 400 lbs.A record review of Resident 3's weight, dated January 12, 2026, indicated the resident weighed 150 lbs. The SAC further stated it is her expectations for the resident's assigned Licensed Vocational Nurse (LVN) to check and verify the residents LAL pumps settings are correct at the beginning of their shifts. On February 11, 2026, at 11:05 a.m., an interview was conducted with LVN 1 who stated LAL mattresses are used as an intervention to prevent the development of PU's. LVN 1 stated LAL mattress pumps are set according to the resident's weight, and the dial should be lined up with the yellow arrow on the pump. LVN 1 stated when the pump is set correctly the air pressure is evenly distributed across the resident's body. The LVN stated he checks the correct setting of his assigned resident's LAL pump at the beginning and end of his shift, and after resident care has been provided. LVN 1 verified he was the assigned LVN for Resident 1. LVN 1 stated he did check Resident 1's LAL pump at the beginning Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056229 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 056229 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/11/2026 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 0908 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete of his shift and verified It was good (at the correct setting). LVN 1 verified Resident 1 later received a wound treatment. LVN 1 stated he did not re-check the setting on Resident 1's LAL pump after his treatment and he should have to ensure the resident's pump was at the correct setting. On February 11, 2026, at 11:25 a.m., a concurrent observation of Resident 4's LAL pump, and an interview with LVN 1 was conducted. Resident 4's LAL pump had a yellow arrow placed at 200 lbs., and the resident's pump was set to 285 lbs. LVN 1 verified Resident 4's pump was not set correctly, stating the resident's mattress was over inflated which can make the surface hard and may contribute to the development of PUs. LVN 1 further stated, I don't think I checked on (Resident 4's) mattress (setting) today and I should have. A record review of Resident 4's weight, dated January 12, 2026, indicated the resident weighed 183 lbs. On February 11, 2026, at 11:55 a.m., an interview was conducted with the Director of Nursing (DON) who verified the LAL pump settings correlate with the resident's weight, and she expects the LVN to check the LAL pump at the beginning of their shift and after resident care to ensure the setting is correct. A review of Resident 1's, Face Sheet indicated the resident was admitted to the facility on [DATE], with a diagnosis of traumatic subarachnoid hemorrhage (severe stroke-death to brain cells). A review of Resident 1's Brief Interview for Mental Status (BIMS-a cognitive assessment) indicated the resident had severe cognitive impairment. A review of Resident 1's Doctor's (Drs) Orders dated December 22, 2025, at 10:10 a.m., indicated, . LAL mattress LN (Licensed Nurse) to monitor function, proper set-up and placement .A review of Resident 2's Face Sheet indicated the resident was admitted to the facility on [DATE], with a diagnosis of traumatic subarachnoid hemorrhage. A review of Resident 2's BIMS indicated the resident had severe cognitive impairment. A review of Resident 2's Dr's Orders dated December 30, 2025, at 9:05 a.m., indicated, . LAL mattress LN to monitor function, proper set-up and placement . A review of Resident 3's Face Sheet indicated the resident was admitted to the facility on [DATE], with a diagnosis of anoxic brain damage (brain damage caused by oxygen deprivation). A review of Resident 3's BIMS score indicated the resident had severe cognitive impairment. A review of Resident 3's Dr's Orders dated, November 25, 2025, at 9:21 a.m., indicated, . LAL mattress LN to monitor function, proper set-up and placement . A record review of Resident 4's Face Sheet indicated resident was admitted to the facility on [DATE], with a diagnosis of acute and chronic respiratory failure.A review of Resident 4's BIMS score indicated the resident had severe cognitive impairment. A review of Resident 4's Dr's Orders dated, February 1, 2026, at 1:22 a.m., indicated, . LAL mattress LN to monitor function, proper set-up and placement .A review of the facility's policy and procedure titled, Low Air-Loss Therapy Bed, undated, indicated, Low-air-loss therapy beds inflate to specific pressures based on the height and weight of the patient . Event ID: Facility ID: 056229 If continuation sheet Page 3 of 3