Inspection·September 12, 2023

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 medical record review, the facility failed to ensure one of two sampled residents (Resident 1) was provided the necessary care and services after a fall. Residents Affected - Few * Resident 1 fell while the resident was being transferred by two staff members from the shower chair to the bed. The nursing staff did not conduct a post fall assessment and monitor the resident for any change in condition after the fall. This failure had the potential for Resident 1 not receiving appropriate care in a timely manner. Findings: On 9/7/23, medical record review for Resident 1 was initiated. Resident 1 was readmitted to the facility on [DATE]. Review of Resident 1 ' s History and Physical Examination dated 6/10/23, showed Resident 1 did not have capacity to understand or make decisions. Resident 1 had a diagnosis of osteopenia. Review of the fall risk assessment dated [DATE], showed Resident 1 was a low risk for falls. Review of the MDS Quarterly assessment dated [DATE], showed Resident 1 was totally dependent on two or more staff for transfers to or from the bed. Review of the Interdisciplinary Notes dated 8/31/23, showed on 8/21/23, while two staff members were in the process of transferring Resident 1 from the shower chair to the bed, Resident 1 began grabbing at the staff members arms and clothing causing all three of them to lose their balance. The two staff members lowered Resident 1 to the ground. The fall was not reported at that time. On 8/29/23, the resident exhibited severe pain during a brief change and an x-ray of the right lower extremity was ordered. The x-ray result showed a distal femur fracture, and the resident was sent to the emergency room for evaluation. However, further review of the medical record showed no documented evidence of the fall on 8/21/23. There was no documented evidence of the post fall assessment and monitoring for changes in condition after sustaining the fall on 8/21/23. On 9/7/23 at 1521 hours, an interview was conducted with RNA 1. When asked about Resident 1 ' s fall on 8/21/23, RNA 1 stated she and CNA 1 attempted to transfer Resident 1 from a shower chair to the bed by placing their (CNA 1 and RNA 1) arms underneath Resident 1 ' s armpits. According to RNA 1, Resident 1 held on to RNA 1 ' s shirt so RNA 1 and CNA 1 then placed Resident 1 on the floor because (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: 555295 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 555295 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Regents Point - Windcrest 19191 Harvard Avenue Irvine, CA 92612 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)