Inspection·April 16, 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 interview and record review, the facility failed to ensure care and services were provided in accordance with professional standards of practice for one of two residents (Resident 1) when: Residents Affected - Few 1. The facility did not follow their own policy for diabetes (blood sugar higher than normal) management; and 2. The facility did not follow the physician's order. These failures had the potential to compromise residents' care and well-being. Findings: Review of Resident 1's clinical record indicated Resident 1 was admitted on [DATE] and had diagnoses including type 2 diabetes mellitus (DM II-a disorder characterized by difficulty in blood sugar control and poor wound healing) without complications, chronic kidney disease (a disease characterized by progressive damage and loss of function in the kidney), fracture of second cervical vertebra (a broken bone of second bone in the neck), and traumatic subdural hemorrhage (a condition where blood collects between the skull and the brain's outer covering caused by head trauma). Review of Resident 1's physician's order, dated 2/16/25, indicated Lantus Subcutaneous solution (an insulin to lower blood sugar) 100 unit/ml inject 20 unit subcutaneously at bedtime for DM II, hold for BG (blood glucose) < 100. Review of Resident 1's February 2025 Medication Administration Record (MAR) indicated blood sugar was checked once a day at bedtime for Lantus administration. The MAR indicated Resident 1's blood sugar (BS) at 9 p.m. was: 99 milligrams per deciliter (mg/dL, a unit of measure) on 2/16/25; 89 mg/dL on 2/17/25; 380 mg/dL on 2/18/25; 346 mg/dL on (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 3 Event ID: 555090 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 555090 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Pacific Coast Post Acute 720 East Romie Lane Salinas, CA 93901 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)