Health inspection·December 20, 2024

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of Resident 1's, Bed Hold Notification Policy, dated, November 24, 2024, was signed by resident's Representative, indicating, the desire for a 7-day bed hold, during resident's absence at GACH. Further review of Resident 1's records, titled, Notice of Proposed Transfer/Discharge, dated, November 24, 2024, indicated, a verbal agreement to transfer resident to GACH for, . further evaluation, per (Doctor's) order, on the same date of November 24, 2024. Further review of Resident 1's progress notes, indicated, resident was transferred out of the facility to GACH, on November 24, 2024, and returned to the facility on November 29, 2024. A review of the facility's, Census (A list of facility residents, including admits, discharges, and bed holds,) dated, November 24, thru November 29, 2024, indicated, a female bed was not held/available, per 7-day bed hold wishes of resident's representative, between the dates of November 27 and 28, 2024. On December 4, 2024, at 10:40 a.m., an interview was conducted with the Admissions Coordinator (AC), who stated, when a resident transferred out of the facility to a GACH and chose to have a 7-day Bed Hold, the bed was held for the resident until they returned to the facility wtihin the 7-day duration. The AC further stated, the facility would not permit the admission of a new resident if the only available beds were on bed holds. The AC stated, she and the Marketing Department (MD) were responsible for ensuring beds were held for all residents on 7-day bed holds, and managing the admissions of new residents. On December 4, 2024, at 2:07 p.m., a concurrent interview with the AC, and review of facility census from November 24, 2024, to November 29, 2024, were conducted. The AC confirmed, Resident 1 had been discharged from the facility on November 24, 2024, to a GACH and had a 7-day bed hold ordered. The AC further stated, the MD had received a call from the GACH case manager on November 27, 2024, indicating Resident 1 would be ready for discharge back to the facility on November 28, 2024. The AC stated, an open bed was not available for the resident as the MD had accepted a new admission on [DATE], and placed the new admit in Resident 1's held bed. The AD stated, this left no open female beds until November 29, 2024, which prolonged Resident 1's stay at the GACH for an additional day. On December 4, 2024, at 2:23 p.m., an interview was conducted with the Administrator (Admin), who stated, when a resident had a 7-day bed hold, the resident must be allowed to re-admit to the facility within the 7-day bed hold period. The Admin confirmed, Resident 1 was discharged from the facility on November 24, 2024, with a 7-day bed hold ordered. The Admin stated, the GACH contacted the MD on November 27, 2024, to notify them that the resident would be ready for discharge from the GACH and re-admission to the facility on November 28, 2024. The Admin confirmed, a bed was not held for Resident 1 for the duration of the 7-day bed hold period, and a bed was not available for the resident to re-admit to the facility until November 29, 2024, which extended Resident 1's stay at GACH by one additional day. A review of the facility's Policy, titled, Bed-Holds and Returns, revised, October 2022, indicated, . 1. All resident/representatives are provided written information regarding the facility and state bed-hold policies, which address holding or reserving a resident's bed during periods of absence (hospitalization or therapeutic leave) . 5. The requirement that residents be permitted to return to the facility following hospitalization or therapeutic leave applies to all residents regardless of payer source . 6. Residents who seek to return to the facility within the bed-hold period defined in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555319 If continuation sheet Page 2 of 3 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 12/20/2024 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)

F 0626 the state plan are allowed to return to their previous room, if available . Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555319 If continuation sheet Page 3 of 3