Health inspection·February 27, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 follow its policy and procedure for Administering Medications for one of four sampled residents (Resident 4) when licensed staff did not monitor Resident 4's blood pressure and heart rate every six hours as ordered by resident 4's physician and give Hydralazine (medication to treat high blood pressure) as needed. Residents Affected - Few This failure resulted in Resident 4 a clinically compromised resident being sent to the hospital for evaluation and treatment. Findings: During a review of Resident 4's admission Record (general demographics), the document indicated Resident 4 was last admitted to the facility on [DATE], with diagnoses that included, hypertension (a condition when the blood pressure is high), hemiplegia (weakness that affect one side of the body), type 2 diabetes mellitus (a disease that occurs when your blood sugar is too high), end stage renal disease (a disease when the kidneys are no longer working). During a review of Care Plan Report, indicated, Focus: Resident is at risk for cardiac distress At risk for shortness of breath, chest pain irregular pulse, dizziness, edema, elevated BP (blood pressure), hypotension, altered mental status, headache . Goal: Will have no unrecognized s/s (signs and symptoms) of cardiac distress daily . Interventions: Observe for headache, chest pain, irregular pulse, edema, shortness of breath, elevated BP, dizziness . Monitor pulse rate and BP as ordered . During a review of Weights and Vitals Summary the last seven days prior to Resident 4 being sent to the hospital (February 18, 2025) indicated, were taken on February 17, 2025: 119/76 and February 10, 2025: 121/77. During review of Licensed Nurses Note dated, February 18, 2025, it indicated, Resident was sent to [Name of hospital], at 2340 via gurney accompanied by two from [Name of ambulance company] due to hypertension . During a concurrent interview and review on February 27, 2025, at 11:05 AM, with Licensed Vocational Nurse (LVN 1), the Medication Administration Record (MAR) was reviewed. Medications to be given included hydralazine HCI oral tablet 25 MG (Hydralazine HCI) Give 1 tablet by mouth every six hours as needed for HTN (hypertension) Hold if SBP (systolic blood pressure) < (less than) 110 or HR (heart rate) < 60. There was no blood pressure and heart rate recordings on the MAR from February 1, 2025, to February 17, 2025, except February 18, 2025. LVN 1 stated, I did not check his blood pressure every six hours. (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 02/27/2025 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)