Health inspection·August 22, 2023

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. 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 one of three sampled residents (Resident 1) received medication as ordered. The facility also failed to notify the physician when Resident 1 did not receive this medication. These failures had the potential to compromise Resident 1's health and well-being. Residents Affected - Few Findings: Review of Resident 1's medical record indicated she was admitted to the facility on [DATE] and had the diagnosis of hyperlipidemia (an abnormally high concentration of fats in the blood). Review of Resident 1's [Hospital] Patient Summary, dated 5/24/23, indicated she received rosuvastatin (medication used to treat hyperlipidemia) while she was in the hospital prior to her admission to the facility. The [Hospital] Patient Summary further indicated Resident 1 was to continue receiving rosuvastatin at the facility. Review of Resident 1's Order Summary Report from the facility indicated she had a physician ' s order, dated 5/24/23, for rosuvastatin 20 milligrams (mg, unit of dose measurement) one tablet by mouth at bedtime for hyperlipidemia. Resident 1's medication administration record (MAR) was reviewed. From 5/24/23 to 6/1/23, and from 6/3/23 to 6/4/23, the number 9 was documented in the section designated to document the administration of rosuvastatin 20 mg at bedtime. Further review of the MAR indicated if the number 9 was documented, it meant to See Nurse Notes. Resident 1's Progress Notes from 5/24/23 to 6/1/23, and from 6/3/23 to 6/4/23, were reviewed. The notes indicated the facility did not have Resident 1 ' s rosuvastatin on hand. Some of the documentation regarding Resident 1's rosuvastatin indicated, no supply or no available supply or pending delivery. During an interview and concurrent record review with licensed vocational nurse A (LVN A) on 8/22/23 at 10:23 a.m., LVN A reviewed Resident 1's medical record and confirmed the resident did not receive rosuvastatin 20 mg at bedtime because the medication was not available in the facility. Further review of Resident 1's medical record indicated there was no documentation that the nurses followed up with the pharmacy regarding the delivery of rosuvastatin. There was also no documentation that the nurses notified Resident 1's physician to inform him the resident had not received this medication. (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: 555060 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 555060 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Windsor the Ridge Rehabilitation Center 350 Iris Drive Salinas, CA 93906 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)