Inspection·April 30, 2025

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. 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 obtain a physician ' s order for a blood sugar fingerstick (a method of measuring blood sugar levels in the blood) in accordance with the facility's policy and procedure and care plan for one of four sampled residents (Resident 4) reviewed. Residents Affected - Few This failure had the potential to affect the delivery of care provided to Resident 4. Findings: On 4/30/25 at 8:45 A.M, an unannounced onsite visit at the facility was conducted related to the care of a resident with diabetes (too much sugar circulating in the blood). Resident 4 was admitted to the facility on [DATE] with diagnoses including diabetes mellitus with hyperglycemia (high blood sugar) according to the facility ' s admission Record. An interview was conducted with Resident 4 on 4/30/25 at 10:06 a.m. Resident 4 stated she had a diagnosis of diabetes and was checking her blood sugar twice a day when she was at home. Resident 4 stated her blood sugar was also checked when she was at the hospital. Resident 4 stated she got upset with staff because the staff did not know she had diabetes and was not checking her blood sugar. Resident 4 stated the staff started checking her blood sugar before meals after she told them she had diabetes. Resident 4 stated the first time her blood sugar was checked, the result was over 300 (an abnormal high value). A review of Resident 4 ' s physician ' s orders was conducted. The physician ' s orders dated 4/27/25 indicated, .Insulin Lispro [a fast-acting medication that helps regulate blood sugar levels] .inject as per sliding scale .before meals for DM-2 [diabetes mellitus type 2- a long-term condition in which the body has trouble controlling blood sugar] . There was no physician ' s order for checking Resident 4 ' s blood sugar. During a review of Resident 4 ' s care plan dated 4/28/25, the care plan indicated, .Diabetes: Resident has a diagnosis of diabetes and is at risk for complications .Interventions/Tasks .Blood glucose checks as ordered. Report to physician if blood glucose is outside set parameters . A joint record review and interview on 4/30/25 at 12:03 P.M. was conducted with Licensed Nurse (LN) 1. LN 1 reviewed Resident 4 ' s physician ' s orders in the electronic medical record (EMR) and stated Resident 4 was receiving insulin. LN 1 stated there was no order to check Resident 4 ' s blood sugar prior to administering the insulin. LN 1 stated even without a physician ' s order; the medication nurses still checked Resident 4 ' s blood sugar because Resident 4 was on insulin. LN1 further (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: 056330 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 056330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Reo Vista Healthcare Center 6061 Banbury St. San Diego, CA 92139 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)