F 0727
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Some
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on
a full time basis.
Based on interview and record review, the facility failed to ensure a registered nurse (RN) was scheduled
for eight consecutive hours in a 24-hour period for November 3, 10, 16, 23, 24, 30, 2024 and December 7,
8, 15, 21, 22, 29, 2024.
This facility failure had the potential to result in delayed identification and treatment of life-threatening
medical conditions thus compromising the health and safety of the vulnerable population in the facility.
Findings:
On January 27, 2025, at 8:53 a.m., an unannounced visit to the facility was conducted to investigate
nursing services complain.
On January 27, 2025, at 11:15 a.m., an interview ws conducted with the Director of Staff Development
(DSD). The DSD stated there was an RN who worked during weekends and would be in the facility from 5
a.m. to 7 a.m, and would come back at around 3 p.m. (would work for about three hours). The DSD stated
licensed vocational nurses (LVN) would handle issues in the facility while the RN was out, and would notify
the Director of Nursing via telephone and would give instructions. The DSD was not aware the facility
requires an RN to be in the facility for eight (8) consecutive hours. A concurrent interview and record review
was conducted with the DSD.
A review of the facility's document titled Daily Assignment and Census Sheet, staffing sign-in log sheet and
time card record indicated the following:
- November 3, 2024 (Sunday), RN worked 6.1 hours;
- November 10, 2024 (Sunday), RN worked 6.0 hours;
- November 16, 2024 (Saturday), RN worked 6.0 hours;
- November 23, 2024 (Saturday), RN worked 6.0 hours;
- November 24, 2024 (Sunday), RN worked 6.0 hours;
- November 30, 2024 (Saturday), RN worked 6.0 hours;
- December 7, 2024 (Saturday), RN worked 6.0 hours;
(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 2
Event ID:
056328
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
056328
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/27/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Premier Care Center for Palm Springs
2990 East Ramon Road
Palm Springs, CA 92264
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 0727
- December 8, 2024 (Sunday), RN worked 6.0 hours;
Level of Harm - Minimal harm
or potential for actual harm
- December 15, 2024 (Sunday), RN worked 6.0 hours;
- December 21, 2024 (Saturday), RN worked 6.0 hours;
Residents Affected - Some
- December 22, 2024 (Sunday), RN worked 6.0 hours; and;
- December 29, 2024 (Sunday), RN worked 6.0 hours.
In a concurrent interview with the DSD, she stated the RN worked only six (6) hours a day during the dates
mentioned above. The DSD stated the facility was not compliant with the requirement of having the RN in
the facility for eight (8) consecutive hours.
On January 27, 2025, at 11:25 a.m., an interview was conducted with the DON. The DON stated there was
not enough RN hours to supervise the facility on the dates mentioned above. The DON stated the LVNs
who worked on the weekends would call him when there was a need of RN taska and he will assist by
giving instructions. The DON stated if the LVNs would not be able to do it, he would travel for about one (1)
hour from home to the facility. The DON stated if there were no sufficient RN hours implemented in the
facility, there would be a delay of care and would compromise the health and safety of the residents.
On January 27, 2025, at 12:20 p.m., an interview was conducted with the LVN. The LVN stated he worked
on weekends and if facility needed an RN task, he would call the Director of Nursing (DON). The LVN
stated he could not perform interventions that an RN could do so he would wait for an RN to come to the
facility. The LVN further stated if there was no RN in the facility, it would cause a delay of identification and
treatment of potential life-threatening conditions and could compromise the health and safety of the
residents.
A review of the facility ' s policy and procedure titled Staffing, Adequate, dated October 2025 (sic),
indicated, .It is the policy of this facility to provide adequate staffing to meet the needs of the resident
population .The facility maintains adequate staff on each shift to assure that the resident ' s needs are met .
A review of the facility ' s job description titled Registered Nurse, indicated, .The primary purpose of your
job position is to .meet the physical and psychosocial needs of the resident, in accordance with established
medical practices and the requirements of the state and the policies and goals of this facility .This position
consistently supports and promotes compliance with the Code of Conduct .adhering to applicable Federal,
State, and local laws and regulations, accreditation and licensure requirements .and all policies and
procedures .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056328
If continuation sheet
Page 2 of 2
