Health inspection·November 14, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, record review, and facility policy review, the facility failed to ensure the residents' fingernails were clean and trimmed for 2 (Resident #2 and Resident #136) of 3 sampled residents reviewed for activities of daily living (ADLs). Residents Affected - Few Findings included: A facility policy titled, Activities of Daily Living (ADLs), Supporting, revised 03/2023, revealed, Residents will be provided with care, treatment and services as appropriate to maintain or improve their ability to carry out activities of daily living. The policy specified, 2. Appropriate care and services will be provided for resident's who are unable to carry out ADLs independently, with the consent of the resident and in accordance with the plan of care, including appropriate support and assistance with: a hygiene (bathing, dressing, grooming, and oral care.) 1. An admission Record revealed the facility admitted Resident #2 on 11/20/2007. According to the admission Record, the resident had a medical history that included diagnoses of contracture of the right and left knee, personal history of transient ischemic attack, age-related osteoporosis, hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, and dementia. A quarterly Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 09/16/2024, revealed Resident #2 had a Staff Assessment for Mental Status (SAMS), which indicated the resident was severely impaired in cognitive skills for daily decision making. The MDS indicated that Resident #2 was dependent on staff for all ADLs. Resident #2's care plan, included a focus area initiated 11/27/2018, that indicated the resident required assistance with ADLs because of a history of dementia and cognitive impairment. Interventions directed staff to assist with grooming and trimming of the resident's fingernails. During an observation on 11/12/2024 at 8:19 AM, Resident #2's fingernails were black and curled under. During an interview on 11/13/2024 at 9:32 AM, Certified Nurse Aide (CNA) #1 stated the trimming of a resident's fingernails was done by the restorative nurse aide (RNA). CNA #1 stated Resident #2's fingernails needed to be trimmed and that she noticed this a few weeks ago. According to CNA #1, she told a nurse, but she did not remember who, and the nurse stated she would direct the RNA to trim the resident's fingernails. During an interview on 11/13/2024 at 9:47 AM, Registered Nurse (RN) #3 stated the aides were (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 5 Event ID: 056429 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 056429 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Laurel Convalescent Hospital 7509 N. Laurel Ave Fontana, CA 92336 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)