Health inspection·June 5, 2025

F 0826 Provide specialized rehabilitative services by qualified personnel, when ordered for a resident by a doctor. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews, and record review, the facility failed to ensure that rehabilitation services were rendered in accordance with federal regulations for one of two sampled residents (Resident 48), when Resident 48 received physical therapy (PT- a treatment focused on improving movement, mobility, and physical function) and occupational therapy (OT- a therapy aimed at helping individuals perform daily activities and improve functional independence) services without a physician's order. Residents Affected - Few This failure had the potential to result in uncoordinated and ineffective care, which could negatively impact Resident 48's rehabilitation and overall treatment plan. Findings: During a review of Resident 48's admission Record (clinical record with demographic information), the admission Record indicated, Resident 48 was readmitted to the facility on [DATE], with diagnoses of acute pulmonary edema (condition where fluid suddenly builds up in the lungs, making it difficult to breathe), and muscle weakness. During an observation on June 3, 2025, at 12:48 PM in the gym (Rehabilitation Room), the physical therapist assistant (PTA) assisted Resident 48 with sitting to standing transfers. The PTA provided verbal instructions, guiding Resident 48 through the movement. Resident 48 was able to stand and maintain balance while holding both hands on the front-wheeled walker (FWW, a mobility aid with two wheels designed to provide support and stability while walking). During an observation on June 5, 2025, at 10:18 AM at the gym, the occupational therapist assistant (OTA) guided Resident 48 through two sets of 10 exercises, raising both arms up and down. The OTA provided verbal instructions throughout the session. Resident 48 successfully completed the exercises. During a concurrent record review and interview on June 5, 2025, at 1:00 PM, the Director of Rehab (DOR), the DOR reviewed the PT and OT evaluation and treatment plan, which indicated, . Certification period [a designated timeframe during which a healthcare service or treatment is authorized and meets regulatory or professional standards] of 5/12/25 [May 12, 2025] - 6/10/25 [June 10, 2025] . The DOR confirmed that Resident 48 is currently receiving PT and OT services. A review of Resident 48's clinical records of active physician orders was conducted. There was no documented evidence of a physician's order for PT or OT treatment. Additionally, there was no documented evidence that a physician had been notified of Resident 48's PT and OT services. (Resident 48 (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: 555162 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 555162 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mountain View Post Acute 27555 Rimrock Rd Barstow, CA 92311 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)