Health inspection·March 26, 2024

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the resident's rights were respected, for one of four residents reviewed (Resident 1), when the facility cordless phone was not accessible for private conversations. This failure increased the potential to negatively affect Resident 1's psychosocial well-being. Findings: On March 26, 2024, at 11:36 a.m., an unannounced visit was conducted at the facility for two complaint investigations. On March 26, 2024, at 12:04 p.m., Resident 1 was observed lying in bed on his cell phone. During a concurrent interview, Resident 1 stated his cell phone no longer worked to receive phone calls, but he continued to use it for internet access. Resident 1 stated he needed to use the facility phone to make and receive phone calls. Resident 1 stated the facility had a cordless phone, but it was not available for use. Resident 1 stated he had weekly phone calls with his doctor, and he was not able to receive the calls because staff stated the cordless phone did not work, or staff do not bring it to his room. Resident 1 stated staff told him he needed to go to the nursing station to receive calls. Resident 1 stated it was hard for him to get out of bed and he did not want to have personal conversations in the nursing station. On March 26, 2024, Resident 1's medical record was reviewed. Resident 1 was admitted to the facility on [DATE], and re-admitted on [DATE], with diagnoses which included chronic obstructive pulmonary disease (COPD- a lung condition that makes breathing difficult), diabetes mellitus (abnormal sugar in the blood), and major depression. Resident 1's physician History and Physical dated January 31, 2024, indicated Resident 1 had capacity to understand and make decisions. On March 26, 2024, at 1:14 p.m., an interview was conducted with Certified Nursing Assistant (CNA) 1. CNA 1 stated when a resident received a call on the facility line, the cordless phone was brought to the resident's room. On March 26, 2024, at 1:37 p.m., an interview was conducted with the Social Service Director (SSD). The SSD stated when a resident did not have a personal cell phone the facility cordless phone was used. The SSD stated the facility cordless phone had been broken for the past couple of days. The SSD stated when a resident received a call, the resident would have needed to go to the nursing station. The SSD stated Resident 1's psychologist sent an email Friday March 22, 2024, that he had been (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: 555319 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 555319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunrise Post Acute 3476 W. Wilson St. Banning, CA 92220 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)