Inspection·May 8, 2025

F 0656 Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Level of Harm - Actual harm Residents Affected - Few **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a fall risk care plan to meet the medical, nursing, mental, and psychosocial needs for one (Resident 1) of three sampled residents. This deficient practice resulted in Resident 1 experiencing injury and pain secondary to an unwitnessed fall on 4/26/25. Findings: A review of Resident 1's, admission Record, dated 5/7/25, showed Resident 1 was initially admitted to the facility on [DATE], with diagnoses including hemiplegia and hemiparesis (hemiplegia refers to complete paralysis, while hemiparesis refers to partial weakness) affecting the right side, morbid obesity (a complex chronic disease in which you have a body mass index [BMI] of 40 or higher, with normal range for adults considered to be between 18.5 and 24.9), muscle weakness, dementia (a general term for a group of symptoms that affect thinking, memory, and other cognitive [relating to, being, or involving conscious intellectual activity-such as thinking, reasoning, or remembering] abilities. It's not a single disease, but rather a collection of conditions that can damage brain cells, leading to a decline in mental function), dysarthria (a motor speech disorder caused by weakness or lack of control of the muscles involved in speech production), long term use of anticoagulants (medications that stop blood from clotting too easily), and a history of falling. A review of Resident 1 ' s, Minimum Data Set Section C (MDS-a standardized assessment tool used in long-term care facilities to evaluate residents' health status, functional capabilities, and other relevant information), dated 4/7/25, indicated Resident 1 had a BIMS (Brief Interview for Mental Status - used to identify delirium [a serious change in mental abilities, resulting in confused thinking and a lack of awareness of someone's surroundings] and needed supports in patients living in skilled nursing facilities and long-term care facilities) score of 9, indicating Resident 1 had moderate cognitive impairment (MCI-cognitive deficits that significantly impact daily life. Individuals with moderate MCI experience difficulties with memory, language, judgment, and problem-solving, often requiring assistance with household tasks and finances. They may become confused about where they are or what is happening and struggle with both routine and complex tasks). A review of Resident 1 ' s, MDS - GG, dated 4/7/25, indicated Resident 1 was partially dependent (not completely reliant on others for basic needs like bathing, dressing, or eating, but may need help with some day-to-day activities) on facility staff for self-care, indoor mobility (the ability to move or to be moved. It can describe a person's capacity to walk, move around, or change body position) and functional cognition (how an individual utilizes and integrates his or her thinking and (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: 056300 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 056300 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Granada Rehabilitation & Wellness Center, LP 2885 Harris Street Eureka, CA 95503 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)