Health inspection·October 10, 2024

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 for one of three sampled residents (Resident 1), the facility failed to follow their policy in providing Activities of Daily Living (ADLS) when personal hygiene was not provide as needed and failing to notify responsible party (RP) of Resident 1 ' s shower refusals. Residents Affected - Few This failure has potential in putting Resident 1 ' s health and safety at risk when hygiene needs were not met. Findings: During review of Residents 1 ' s admission Record (general demographics), the document indicated Resident 1 was admitted to the facility on [DATE], with diagnoses to include: cerebral infarction (blood blocked to brain, causing tissue death), Benign Prostatic Hyperplasia (enlarged prostate) Neurogenic Bladder (bladder retention), Urinary tract infection, schizoaffective disorder (hallucination s, delusions), hypertension (high blood pressure). During a concurrent interview and record review of Resident 1 ' s Medical Record with the Director of Nursing (DON), reviewed are as follows: 1. Task ALDs Shower /Bath self from September 11, 2024- October 09, 2024, 22 bed baths recorded, only 2 showers: September 01, 2024, Hair washed, skin moisturized marked Yes (Nails trimmed and shaved marked No) September 05, 2024, hair washed, skin moisturized shaved marked, shower and skin check marked Yes, nails trimmed marked No. 2. Careplan (No documentation of shower refusals). 3. No Progress Notes of documentation of shower refusals. 4. No Change in Condition for shower refusals, No responsible party notification. During an interview on October 10, 2024, with the Director of Staff Development (DSD), the (DSD) stated, For showers, we were told to chart it down, we go back 3 times after they refuse to see if the resident changes their mind in taking a shower. The charge nurse and the Certified Nursing Assistant (CNA) documents shower refusals. I printed out the bed baths provided, but I only have 2 shower sheets since September 1, 2024, until now. I don ' t know what happened. I ' m not sure for this (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: 555089 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 555089 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meadows Ridge Care Center 1700 E Washington St Colton, CA 92324 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)