Health inspection·April 24, 2025

F 0825 Provide or get specialized rehabilitative services as required for a resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, and facility P&P review, the facility failed to ensure the rehabilitation services were provided for one of four sampled residents (Resident 1). Residents Affected - Few * The facility failed to ensure Resident 1 received the PT and OT services for the planned duration and frequency as documented in the initial PT and OT evaluation. This failure had the potential for Resident 1 to decline in the resident's range of motion and mobility. Findings: Review of the facility's P&P titled Purpose and Objectives of Inpatient Rehabilitation Services revised 12/2022 showed it is the objective of the rehabilitation department to provide comprehensive and integrated therapy services to restore patients to their highest level of function. The therapists will develop an individualized plan of care upon evaluation and continuous assessment during treatment plan. Review of the facility's P&P titled Physician Orders for Rehab Services revised 12/2022 showed the evaluating therapist must establish the therapy plan of care after completion of initial assessment. The plan of care shall include at a minimum, short-term and long-term goals, treatment modalities, frequency and duration of treatment and treatment diagnosis. Closedmedical record review for Resident 1 was initiated on 4/15/25. Resident 1 was admitted to the facility on [DATE], and discharged on 3/14/25. Resident 1 had a diagnosis of spinal stenosis with neurogenic claudication. Review of the Order Summary Report showed the following physician's order dated 2/28/25: - to evaluate and treat for OT as needed for rehabilitation as indicated for three days; and - to evaluate and treat for PT as needed for rehabilitation as indicated for three days. Review of Resident 1's PT Evaluation and Plan of Treatment for the certification period for 3/1 to 3/30/25, showed the plan of treatment frequency for the therapeutic exercises, neuromuscular re-education, gait training therapy; PT evaluation: moderate complexity; and therapeutic activities with frequency of five times a week for the duration of two weeks. Review of Resident 1's OT Evaluation and Plan of Treatment for the certification period for 3/3 to 4/1/25, showed the plan of treatment for the therapeutic exercises, group therapeutic procedure; OT (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: 555308 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 555308 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/24/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Trabuco Hills Post Acute 25652 Old Trabuco Road Lake Forest, CA 92630 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)