Health inspection·October 28, 2024

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility staff failed to identify, assess, and notify the attending physician for one of three sampled residents (Resident 1) when Resident 1 had no urine output (UO) for more than 24 hours and no stool output (bowel movement, BM) from her colostomy (stools moving through the intestine draining into a bag that is attached to the skin of the abdomen) bag. In addition, Resident 1 ' s output was not documented consistently in Resident 1 ' s clinical record. This failure had the potential for Resident 1 to have urinary tract infection (UTI) and went untreated. Findings: On 10/7/24 and on 10/15/24, the Department received complaints related to quality of care for Resident 1. On 10/21/24, an unannounced visit to the facility was conducted. Resident 1 was admitted to the facility on [DATE], with diagnoses which included stroke, pressure ulcer (areas of damage to the skin and the tissue underneath), and rectal cancer, per the facility's admission Record. On 10/21/24, a review of Resident 1 ' s minimum data set (MDS – a federally mandated assessment tool), dated 9/16/24, indicated Resident 1 had a brief interview for mental status (BIMS, ability to recall) score of 15/15 which indicated Resident 1 had an intact cognition. Per MDS, Resident 1 had a colostomy upon admission. On 10/21/24 at 1:11 P.M., a concurrent review of Resident 1 ' s clinical record and an interview was conducted with Certified Nursing Assistant (CNA) 1. CNA 1 stated Resident 1 was on bladder training (the goals are to increase the amount of time between emptying the bladder and the amount of fluids the bladder can hold) and had colostomy. CNA 1 stated for residents with colostomy, the CNAs monitor the resident ' s BM and documented the size and consistency of the BM. CNA 1 stated one of the responsibilities of the CNAs was to ensure the colostomy bags were emptied and the site was not infected. CNA 1 stated the CNAs were to report to the charge nurse when the resident did not have UO or BM. Per Resident 1 ' s clinical record, Resident 1 ' s BM in the colostomy bag were documented in the following dates and shifts. (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 4 Event ID: 555076 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 555076 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stillwater Post-Acute 510 E. Washington Avenue El Cajon, CA 92020 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)