Health inspection·December 5, 2025

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. 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 Physician ordered restorative nursing services (a program that helped residents maintain or improve their highest possible level of physical function) was provided to one out of 24 sampled residents (Resident 15). This failure had the potential for a decline in functional status and to negatively impact psychosocial well-being.Findings:A review of the facility's undated policy and procedure (P&P) titled, Restorative Nursing Program, indicated, residents would receive restorative nursing care as needed to maintain safety and independence in their functional ability. A review of Resident 15's admission Record, dated 7/15/25, indicated, Resident 15 was admitted to the facility on [DATE] with the diagnoses of muscle weakness and difficulty in walking (ambulation). Resident 15 was their own responsible party (decision maker). A review of the Quarterly Minimum Data Set (MDS, an assessment tool), dated 10/16/25, indicated that a Brief Interview for Mental Status (BIMS, an assessment tool used by facilities to screen and identify memory, orientation, and judgement status of the resident) assessment was conducted. Resident 15 scored a 14 out of 15, indicating good memory. The MDS indicated Resident 15 required staff supervision while ambulating. During an interview on 12/2/25 at 2:15 pm, Resident 15 stated, I'm done with my rehab [therapy that helped a person regain their independence], but I'm still here. Resident 15 denied receiving restorative nursing services and stated, I had it twice. During a review of the care plan (a detailed plan that included resident goals and resident care instructions) titled, RNA [Restorative Nurse Assistant] Program, dated 10/22/25, indicated, Resident 15 would receive assistance from the RNA to ambulate 50 to 100 feet three times a week or as tolerated. The care plan indicated, Resident 15's goal was to maintain strength and activity tolerance to prevent a decline in functional mobility. The care plan indicated Resident 15 required a four-wheeled walker (a metal frame on wheels that was used to assist with ambulation) and facility staff to stand by and assist as needed while ambulating. During an interview on 12/3/25 at 2:56 pm, Physical Therapist (PT) stated, when PT discharged the resident from the therapy program, we establish the RNA program with written instructions for what the RNA will do with the resident. PT confirmed, a referral to RNA program for Resident 15 was provided to the nursing department. A review of the Restorative Nursing Program Referral, dated 10/22/25, indicated, PT referred Resident 15 to the restorative nursing program for ambulation three times a week or as needed and required staff assistance with ambulation for safety. A review of the Physician's order, dated 10/22/25, indicated Resident 15 would receive restorative nursing services three times a week for ambulation. During a concurrent interview and record review on 12/3/25 at 3:04 pm, with RNA, Resident 15's RNA documentation (an untitled document that indicated what days of the week the resident received restorative nursing care), dated 10/21/25 through 12/1/25 was reviewed. RNA confirmed, the RNA documentation indicated that Resident 15 did not receive documented restorative nursing care from 10/22/25 to 11/10/25. RNA confirmed, the RNA documentation indicated, Resident Residents Affected - Few (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 3 Event ID: 555316 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 555316 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Copper Ridge Care Center 201 Hartnell Avenue Redding, CA 96002 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)