Health inspection·February 14, 2024

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 hold a blood pressure (BP) medication as prescribed by the physician for one resident (Resident 1) with a low BP. Residents Affected - Few As a result, Resident 1's BP had the potential to further decrease below normal and increase the risk of harmful side effects. Findings: Resident 1 was admitted to the facility on [DATE] with heart failure (a condition where the heart dose not pump enough oxygen rich blood to the body), per the resident's admission record. A review of Resident 1's physician orders, active January 2024, indicated Resident 1 was prescribed one 25 milligram (mg) tablet of metoprolol (a medication used to decrease blood pressure and heart rate) two times a day for hypertension (high blood pressure). The physician's order indicated instructions to hold the metoprolol if Resident 1's systolic blood pressure (SBP, the number of the BP reading that indicates the pressure on the blood vessels when it contracts) number was below 110 or heart rate below 60. On 2/14/24 at 3:10 P.M., an interview and concurrent record review was conducted with the infection preventionist/Licensed Nurse (IP/LN). Resident 1's medication administration record (MAR) was reviewed with IP/LN. The IP/LN stated the physician's administration instructions on the MAR indicated Resident 1's metoprolol should held if the SBP reading was below 110. The MAR indicated the IP/LN had documented Resident 1's BP was 102/86 on 1/24/24 at 9:00 A.M., and that she had administered one 25 mg tablet of metoprolol to Resident 1. The IP/LN stated she should not have given Resident 1 the metoprolol on 1/24/24 because his BP was below 110. The IP/LN stated it was important to check physician orders before administering medication because if it is given when it should not be it could cause harm to the resident. A record review was conducted of Resident 1's January 2024 MAR. The MAR indicated Resident 1 was administered one tablet of metoprolol 25mg when his SBP was below 110 on the following dates: 1/5/24 at 9:00 A.M., BP 109/59 admin by LN 31/8/24 at 5:00 P.M., BP 94/64 admin by LN 41/14/24 at 9:00 A.M., BP 97/53 admin by LN 31/24/24 at 9:00 A.M., BP 102/86 admin by IP/LN On 2/24/24 at 3:20 P.M., an interview and concurrent record review of Resident 1's January MAR was conducted with the director of nursing (DON). The DON stated the LN's should have known to check Resident 1's BP against the physician's order instructions for metoprolol. The DON stated Resident 1 (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: 555136 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 555136 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Poway Healthcare Center 15632 Pomerado Road Poway, CA 92064 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)