Health inspection·February 6, 2024

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 record review, the facility failed to ensure a person-centered care plan was updated for one of three residents (Resident 1) reviewed with osteoporosis (bone disease; weak, brittle bones). This failure had the potential to miscommunicate care related to Resident 1 ' s health and safety when providing care, assistance, and repositioning for Resident 1. Residents Affected - Few Findings: A record review of Resident 1's face sheet (contains demographic information) indicated Resident 1 was admitted to the facility on [DATE] with diagnoses that included respiratory failure (a serious health condition; difficulty breathing). A record review of Resident 1's Minimum Data Set (MDS; nursing assessment tool), section B0100, dated 11/14/23, indicated .comatose . persistent vegetative state /no discernible consciousness (individual does not show signs of awareness). This section was coded as yes. A record review of Resident 1's portable chest x-ray, signed by the medical doctor (MD), dated 1/5/23, indicated .Probable small bilateral pleural effusions (build-up of fluid in the tissues that line the lungs and chest). Bones are osteopenia (condition that occurs when the body does not make new bone) . A record review of Resident 1's x-ray of the left toe, signed by the MD, dated 8/3/23, indicated .osteopenia and flexion deformity of the toes . A record review of Resident 1's document titled Physician Progress Note, dated 1/15/24, indicated .The patient's left humerus fracture was most likely related [to] staff moving his left arm while turning, dressing, shifting in bed in combination with osteoporosis . An interview was conducted on 1/22/24 at 11:59 A.M. with CNA (certified nursing assistant) 3, in the conference room. CNA 3 stated that he worked with Resident 1 on 1/15/24, the morning of when the fracture was first discovered. CNA 3 stated that Resident 1 required two-person assistance with transfers, repositioning, and all care. CNA 3 stated Resident 1 was bed-bound (no longer able to move easily; confined to a bed). An interview was conducted on 1/22/24 at 12:21 P.M. with CNA 4, in the conference room. CNA 4 stated that Resident 1 used to transfer to a wheelchair with a Hoyer lift (mechanical lift that assisted with resident transfers) but stated that he has not seen Resident 1 out of bed, as of date. CNA 4 stated that after the incident with Resident 1's left arm fracture, that an in-service (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 02/06/2024 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)