Inspection·December 9, 2025

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few was to document that she notified NP each time, and that NP did not respond. LN 2 stated the importance of timely notification, response, and documentation was to provide the right intervention for Resident 1 in timely manner. LN 2 stated she asked the medication nurse (LN 3) to check on Resident 1 throughout the incident. LN 2 stated that she was not sure why there was no progress note from LN 3 about Resident 1's CIC in the EMR . Review of Infection Preventionist's (IP) CIC note written on 11/19/25 at 3:12 P.M., indicated, Resident's daughter reported that patient has increased confusion. Rehab staff also reported that patient was c/o [complained of] RLQ abdominal pain during therapy. Upon assessment, patient was alert but confused. RLQ noted with mild tenderness when palpated (touched). No guarding [of the abdomen] observed. Abdomen also slightly distended. BP 127/81. Pulse of 107.Date and time of clinician notification 11/19/25 at 15:00(3 P.M.).Date and time of family/resident representative notification 15:00.On 12/10/25 at 8:09 A.M., a phone interview was conducted with LN 3. LN 3 stated that she initially saw Resident 1 when she gave him his medication in the morning around 8:30 A.M. LN 3 stated that at 12 P.M. on 11/19/25, Resident 1 was complaining of RLQ abdominal pain. LN 3 stated that she only spoke to the daughter when the therapist came to talk to her about Resident 1's change of condition. LN 3 stated that resident's daughter was dealing mainly with the nurse, LN 2. LN 3 stated that she assessed resident, did vital signs, assessed resident's abdomen, assessed the resident's urinary catheter, and mental status. LN 3 stated that Resident 1 was confused and had dark yellow urine in foley catheter. LN 3 stated that he had no fever, but they were suspecting a possible UTI. LN 3 stated that she texted the NP at about 12:35 P.M. without response. LN 3 stated that NP did not return her text the first time and after they texted a second time with no response (time not remembered), and her charge. LN 2 called the NP directly at 3 P.M. LN 3 stated that she should have documented Resident 1's condition after assessing resident and again after talking with the NP after contacted about CIC. LN 3 stated she should have charted when she texted NP, and that NP did not respond. LN 3 stated that she did not chart that day because she had been busy that day, and that her charge nurse charted a COC (change of condition) at 3 PM. LN 3 stated the importance of timely documentation was because if it was not documented it was not done. LN 3 stated when the change of condition occurred, she should have contacted the MD or NP within the first 30 minutes to an hour, so they can make timely interventions for the Resident. LN 3 stated that 3 hours was too long.Review of facility document titled eINTERACT Change in Condition Evaluation V5.1 dated 11/19/2025 at 19:35 [7:35 P.M.] indicated The change in condition.Abdominal firm to palpitation and catheter.started 11/19/25 in afternoon.Family notified Charge nurse of persistent abdominal pain from morning. Assessment done and found firmness of abdomen upon palpation. Bowel sounds normal on auscultation. Catheter found with no urine 100CC removed in the morning and 300 CC on bladder scan. Family requested to send to the ED(Emergency Department) for further evaluatIon d/t increased concern.Review of facility document titled eInteract Transfer Form V5 dated 11/19/25 at 7:55 P.M. indicated Resident 1 was transferred to the hospital on [DATE] at 8 P.M. for Family request d/t [due to} increased abd [abdominal] pain and transfer was unplanned.On 12/18/25 at 11:02 A.M., an interview was conducted with the Director of Nursing (DON). The DON stated that notification and documentation of change of condition should be accurate and done in a timely manner. The DON stated that if you didn't document it, you can't prove that you did it.Review of facility policy titled Change in a Resident's Condition or Status dated 2001 indicated The nurse notify the resident's attending physician on call when there has been a(an). d. significant change in the resident's physical/emotional/mental conditions.2. A significant change of condition is a major decline or improvement in resident's status that will not normally resolve itself without intervention by staff or by implementing standard disease related (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056330 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 056330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2025 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)

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete clinical interventions (is not self-limiting) ).d. ultimately based on the judgment of the clinical staff and the guidelines outlined in the Resident Assessment Instrument.Review of facility policy and procedure titled Charting and Documentation dated 2001, indicated, All services provided to the resident.or any changes in the resident's medical, physical, psychosocial condition, shall be documented in the resident's medical record. The medical record should facilitate communication between the interdisciplinary team regarding the resident's condition and response to care.2. The following information is to be documented in the resident medical record.d. Changed in the resident's condition.7. Documentation of procedures and treatments will include care-specific details including: .c. the assessment data and/or any unusual findings obtained during procedure/treatment.f. notification of family, physician, or other staff. Event ID: Facility ID: 056330 If continuation sheet Page 3 of 3