Health inspection·December 13, 2023

F 0726 Level of Harm - Minimal harm or potential for actual harm Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Based on interview and record review, the facility failed to ensure staff followed policy and procedure for reporting a change of condition to the physician for one of two sampled residents (Resident 1) . Residents Affected - Few This facility failure resulted in delay of care for Resident 1. Findings: During a record review of Resident 1's Physical Therapy Progress Note, dated 9/25/23. The Physical Therapy Progress Note indicated, Resident 1 had diagnoses including, fracture (broken bone) of unspecified part of neck of left femur (thigh bone), subsequent encounter for closed fracture with routine healing, history of falling, chronic pain syndrome, cerebral infarction (occurs as a result of disrupted blood flow to the brain), and difficulty in walking. During an interview on 11/16/23 at 12:13 p.m. with Physical Therapist (PT 1), PT 1 stated she told licensed nurse (LN 1) that she wasn't getting Resident 1 up today (10/31/23) because something was wrong and she thought Resident 1 should have an x-ray. PT 1 stated LN 1 told her that LN 1 would notify the MD to get an x-ray. During a concurrent interview and record review on 11/16/23 at 12:45 p.m. with LN 1, Resident 1's Daily Skilled Progress Note, dated 10/31/23, was reviewed. The Daily Skilled Progress Note indicated, there was no documentation LN 1 asked certified nursing assistant (CNA 1) to reposition Resident 1, or that LN 1 assessed Resident 1 after CNA repositioned her. LN 1 stated PT 1 told her Resident 1's left lower extremely (LLE) looked suspicious, like it was out of line. LN 1 then asked CNA 1 to reposition her but did not assess Resident 1 after repositioning. Additionally, LN 1 stated I did not call Resident 1's MD but called the orthopedic clinic and left a message, I never spoke to anyone. During a concurrent interview and record review on 11/16/23 at 1:15 p.m. with LN 2, LN 2 stated I came in the morning of 11/1/23 and noticed Resident 1 was in pain and that one leg was shorter than the other so I called the MD to get an x-ray. LN 2 confirmed if PT 1 had told me something was wrong with Resident 1, I would assess Resident 1 and if LLE was shorter than the other or looked out of align, I would notify MD to get an x-ray, that is the nursing process that I follow. During an interview on 11/16/23 at 1:48 p.m. with Director of Nursing (DON), DON stated the expectation is if PT brings a problem to a LN, LN should assess the resident and document in clinical record that resident was assessed, what interventions were done, and to contact the resident's MD for orders. Additionally, DON confirmed that wasn't done when PT 1 brought concern to LN 1 about 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: 555220 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 555220 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/13/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vineyard Hills Health Center 290 Heather Court Templeton, CA 93465 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)