Health inspection·February 26, 2026

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to implement its infection prevention and control program to prevent the transmission of infectious organisms when staff failed to properly maintain urinary catheter drainage systems and ensure resident care equipment was stored in a manner that prevented contamination.1. Urinary catheter drainage bags for four residents were observed resting on the floor, creating risk for contamination of the closed urinary drainage system.2. Resident care equipment (bedpans and urinals) in shared bathrooms were not labeled, creating potential for cross-use between residents.These failures created conditions conducive to the transmission of multidrug-resistant organisms and catheter-associated urinary tract infections and had the potential to place residents at risk for acquiring infections.Findings: Residents Affected - Some 1. During a concurrent observation and interview on 2/24/26 at 10:26 a.m. with Certified Nursing Assistant (CNA) 2, Resident 5 was observed in bed with urinary catheter drainage bag touching the floor. CNA 2 confirmed Resident 5's urinary catheter drainage bag was on the floor. During a review of the Resident Demographics (Face Sheet), the Face Sheet indicated Resident 5 was admitted to the facility on [DATE] with diagnoses which included benign prostatic hyperplasia (noncancerous enlargement of the prostate gland). During a review of Resident 5's Physician's Orders, dated 2/2/26, the Physician's Orders indicated, Foley Catheter [indwelling tube inserted into the bladder to continuously drain urine into collection bag] every shift. During a concurrent observation and interview on 2/24/26 at 10:46 a.m. with CNA 3, Resident 47 was observed in bed with urinary catheter drainage bag positioned on the floor. CNA 3 confirmed Resident 47's urinary drainage bag was positioned on the floor. During a review of the Resident Demographics (Face Sheet), the Face Sheet indicated Resident 47 was admitted to the facility on [DATE] with diagnoses which included neuromuscular dysfunction of the bladder (loss of normal bladder control due to nerve damage). During a review of Resident 47's Physician's Orders, dated 9/24/25, the Physician's Orders indicated, Closed system Foley Catheter [indwelling tube inserted into the bladder to continuously drain urine into collection bag] for Neurogenic Bladder (condition where nerve damage disrupts bladder control.) During a concurrent observation and interview on 2/24/26 at 10:49 a.m. with CNA 3, Resident 130 was observed in bed with urinary catheter drainage bag positioned on the floor. CNA 3 confirmed Resident 130's urinary drainage bag was positioned on the floor. During a review of the Resident Demographics (Face Sheet), the Face Sheet indicated Resident 130 was admitted to the facility on [DATE] with diagnoses which included neuromuscular dysfunction of the bladder (loss of normal bladder control due to nerve damage). During a review of Resident 130's Physician's Orders, dated 9/24/25, the Physician's Orders indicated, Foley Catheter [indwelling tube inserted into the bladder to continuously drain urine into collection bag] for neurogenic bladder (condition where nerve damage disrupts bladder control.) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056444 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 056444 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/26/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Community Extended Care Hospital of Montclair 9620 Fremont Ave Montclair, CA 91763 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 0880 Level of Harm - Minimal harm or potential for actual harm During an observation on 2/23/26 at 10:40 a.m. in Resident 52's room, the urinary drainage bag was observed touching the floor. During an interview on 2/24/26 at 11:00 a.m. with Licensed Vocational Nurse (LVN) 2, LVN 2 stated the urine drainage bag should not be touching the floor. Residents Affected - Some During an interview on 2/25/26 at 1:43 p.m. with Infection Preventionist (IP), the IP stated that urinary catheter drainage bags should not touch the floor. IP further stated when urinary drainage bag or tubing touched the floor, contaminants could be introduced to the resident. During a review of the facility's policy and procedure (P&P) titled, Infection Control Program System, dated January 2023, the P&P indicated, The facility maintains written standards, policies and procedures for the infection control program, which includes.Standard and transmission-based precautions to be followed to prevent the spread of infection. 2. During a concurrent observation and interview on 2/24/26 at 10:57 a.m. with CNA 4, there was an unlabeled bedpan and unlabeled urinal in Resident 36's shared bathroom. CNA 4 confirmed the bedpan and the urinal were unlabeled and was unsure which resident the bedpan and urinal belonged to. During a concurrent observation and interview on 2/24/26 at 1:57 p.m. with CNA 5, unlabeled bedpan next to the toilet in Resident 3's shared bathroom. CNA 5 confirmed the bedpan next to the toilet was unlabeled and was unsure which resident the bedpan belonged to. During an interview on 2/25/26 at 1:43 p.m. with IP, the IP stated that bedpans and urinals should be labeled with resident's name and stored in the resident's designated closet. IP further stated that unlabeled bedpans and urinals left in the shared restroom could lead to cross contamination. During a review of the facility's P&P titled, Infection Control Program System, dated January 2023, the P&P indicated, The facility maintains written standards, policies and procedures for the infection control program, which includes.Standard and transmission-based precautions to be followed to prevent the spread of infection. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056444 If continuation sheet Page 3 of 3