Inspection·December 10, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 ensure the residents' pressure ulcers (injuries to the skin and the tissue below the skin that are due to pressure on the skin for a long time) had weekly assessment for four of seven residents (1, 2, 3, and 4). This failure resulted in undetermined wound status and had the potential to negatively affect the healing of the wounds and/or to cause the deterioration of the wounds. Residents Affected - Some Findings: Review of Resident 1's admission Record indicated she was admitted to the facility on [DATE] with diagnoses including severe obesity, muscle weakness, and cognitive communication deficit. Review of Resident 1's clinical record indicated she had a pressure ulcer stage 2 (a partial-thickness skin loss that appears as a shallow, open wound with a red or pink wound bed) on her sacrum (a large, triangular bone at the base of the spine), but her sacral pressure ulcer was not assessed from 11/8/24 to 12/2/24. Review of Resident 2's admission Record indicated he was admitted to the facility on [DATE] with diagnoses including muscle weakness, difficulty in walking, iron deficiency, vitamin deficiency, and dementia (loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life). Review of Resident 2's clinical record indicated he had an unstageable pressure ulcer (a full-thickness pressure injury in which the base is obscured by soft, yellow, white and/or thick, dry, black, brown dead tissue) on his sacrum, but his sacral pressure ulcer was not assessed from 11/13/24 to 12/2/24. Review of Resident 3's admission Record indicated she was admitted to the facility on [DATE] with diagnoses including severe obesity, muscle weakness, and peripheral vascular disease (the reduced circulation of blood to a body part, other than the brain or heart, due to a narrowed or blocked blood vessel). Review of Resident 3's clinical record indicated she had a deep tissue pressure injury (DTPI, a serious form of pressure injuries; the condition remains invisible for up to 48 hours and then progresses rapidly to full-thickness skin and soft tissue loss) on her right lateral foot, but her right lateral foot DTPI was not assessed from 11/13/24 to 12/2/24. Review of Resident 4's admission Record indicated he was admitted to the facility on [DATE] with (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: 056437 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 056437 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Cypress Ridge Care Center 1501 Skyline Drive Monterey, CA 93940 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)