Health inspection·September 18, 2023

F 0625 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to offer bed hold for two residents who were transferred to the acute hospital. (Resident 5 and Resident 6) This failure had the potential for the residents to not be aware of their choice to hold a bed at the facility when transferred to the hospital. Findings: Resident 5 was admitted to the facility on [DATE] with diagnoses including wound care, leaking colostomy (an opening for the colon or large intestine through the abdomen) according to the facility ' s Patient Information. On 9/14/23, at 11:36 A.M., a concurrent review of Resident 5 ' s nursing note with the Director of Nursing (DON) was conducted. The DON stated Resident 5 was transferred to the hospital on 3/23/23 due to shortness of breath, with cold and clammy skin. During an interview and concurrent record review on 9/14/23, at 12:10 P.M., with the nursing supervisor (NS), the NS stated if a resident was transferred to the hospital, the nursing staff called the resident or the responsible party to inquire if a bed hold was requested. The NS stated the form titled, Notice of Resident Transfer and Discharge, was used for bed holds. The NS reviewed the form from Resident 5 ' s chart and stated she did not know why the form was blank. The NS further stated she was not sure if bed hold was offered. Resident 6 was admitted to the facility on [DATE] with diagnoses including congestive heart failure (a condition in which the heart does not pump or fill blood as well as it should) according to the facility ' s Patient Information. On 9/14/23, at 11:36 A.M., a concurrent review of Resident 6 ' s nursing note with the Director of Nursing (DON) was conducted. The DON stated Resident 6 was transferred to the hospital on 3/22/23 due to chest pain. Further concurrent review of Resident 6 ' s records was conducted with the DON on 9/14/23, at 12:15 P.M. A form titled, Notice of Resident Transfer and Discharge was in Resident 6 ' s chart. The DON confirmed that the form was blank. The DON stated she was unsure what the facility policy was regarding bed hold. (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: 555301 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 555301 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Villas at Poway 15615 Pomerado Rd 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)