Inspection·April 14, 2025

F 0921 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview and record review, the facility failed to ensure residents' rooms were maintained clean and comfortable when: 1. room [ROOM NUMBER] had adhesive residue, chipped paint and black horizontal lines across the wall in front of the residents' bed, chipped baseboards and the floor had yellow and black stains; and 2. room [ROOM NUMBER] had adhesive residue, chipped paint and black horizontal lines across the wall in front of the residents' bed. This failure had the potential to negatively impact the psychosocial well-being of Residents 1, 2, 3, 4, 5 and 6. Findings: On March 27, 2025, at 10:54 a.m., during an observation in room [ROOM NUMBER], there were three residents, Residents 1, 2 and 3. The wall in front of them had adhesive residue, chipped paint, black horizontal lines and chipped baseboard. The floor had yellow and black stains. On March 27, 2025, at 10:58 a.m., during an observation in room [ROOM NUMBER], there were three residents, Residents 4, 5 and 6. The wall in front of them of them had adhesive residue, chipped paint and black horizontal lines. On March 27, 2025, at 11:35 a.m., during a concurrent interview with the Maintenance Director (MTD) and observation of room [ROOM NUMBER], the MTD stated the black horizontal lines and chipped baseboard were from when the residents' bed or wheelchair touched the wall. The MTD stated the chipped paint and adhesive residue were from when he moved the electrical outlets up behind the televisions. The MTD stated the floor was old, had stains on it and was not clean. The MTD stated they tried to clean the floor, but the stains were not removed. The MTD stated the floor should be changed. On March 27, 2025, at 11:40 a.m., during a concurrent interview with the MTD and observation of 49, the MTD stated there were adhesive residue, chipped paint and black horizontal lines on the wall. The MTD stated the black horizontal lines were from when the residents' bed or wheelchair touched the wall; and the chipped paint and adhesive residue were from when he moved the electrical outlets up behind the televisions. The MTD stated they started renovating the facility including residents' rooms three years ago. There are still some rooms that needed to be renovated including rooms [ROOM NUMBERS], but the residents did not want to move out. The MTD stated he cannot do any repairs or (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: 555017 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 555017 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverwalk Post Acute 4000 Harrison Street Riverside, CA 92503 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)