Health inspection·September 9, 2025

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, closed medical record review, and facility P&P review, the facility failed to provide the necessary treatment and services to maintain the highest practicable well-being for one of five sampled residents (Resident 3). * The facility failed to ensure Resident 3's change in condition of aggressive behavior was monitored every shift for 72 hours. In addition, the facility failed to ensure Resident 3's plan of care was revised to address Resident 3's recent behavioral episode. This failure had the potential to negatively affect Resident 3's health and well-being and the potential risk of not providing Resident 3 with appropriate and individualized care.Findings: Review of the facility's P&P titled Care Plan Revisions Upon Status Change revised 12/19/22, showed the comprehensive care plan will be reviewed and revised as necessary, when a resident experiences a status change. The care plan will be updated with the new or modified interventions. Closed medical record review for Resident 3 was initiated on 9/5/25. Resident 3 was admitted to the facility on [DATE]. Review of Resident 3's H&P examination dated 3/16/25, showed Resident 3 had the capacity to make medical decisions. a. Review of Resident 3's progress notes dated 6/20/25 at 1930 hours, showed Resident 3 was observed exhibiting aggressive behavior, barricading himself in the room, yelling and posing as a danger to himself and others. The licensed nurse documented the IM (intramuscular) Ativan (antianxiety medication) was being administered as ordered by the physician and the resident would be monitored closely for safety. Review of Resident 3's eINTERACT Change of Condition Report dated 6/20/25 at 2000 hours, showed Resident 3 exhibited physical aggression with episodes of hitting and refusal of the medication. However, further review of Resident 3's medical record failed to show the resident's change in condition was monitored after the resident's initial change in condition was observed. b. Review of Resident 3's plan of care showed a care plan problem dated 3/20/25, addressing Resident 3's mood problem, with the goal for the resident to have improved mood state. However, further review of Resident 3's plan of care failed to show the resident's care plan was revised to include the interventions associated with the resident's change of condition regarding the recent episodes of the physical aggression on 6/20/25. On 9/5/25 at 1612 hours, an interview and concurrent closed medical record review was conducted with RN 2. RN 2 verified Resident 3's care plan was not revised to reflect the new interventions and monitoring of the resident's status related to the recent episodes of the physical aggression on 6/20/25. RN 2 stated for the residents with a change in condition, the residents should be monitored for a minimum of 72 hours and documented in the resident's progress notes. RN 2 verified there was no documented evidence to show Resident 3's condition was monitored for 72 hours, after the resident's initial change in condition was observed and documented. On 9/9/25 at 1500 hours, an interview was conducted with the Administrator and DON. The Administrator and DON were informed and acknowledged the above findings. Residents Affected - Few 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 09/09/2025 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)