Health inspection·February 6, 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 Based on observation, interview, and record review, the facility failed to conduct and complete neurological assessment (neuro checks - assessment of neurological function and [LOC]-level of consciousness) for the first hour after an unwitnessed fall for one out of three sampled residents (Resident 1). Residents Affected - Few This failure had the potential to result in serious consequences, including loss of consciousness, seizures (uncontrolled movements), and coma (unable to wake up) which could go undetected. Findings: On January 16, 2025, at 9:25 a.m., an unannounced visit was made to the facility for a quality-of-care issue. On January 16, 2025, at 9:35 a.m., a concurrent observation & interview with Resident 1 was conducted. Resident 1 was observed in her room, lying face down on the floor next to her bed. Resident 1 was turned over onto her back, then helped to sit on her bed, by Licensed Vocational Nurse (LVN 1) and a Certified Nursing Assistant (CNA). Observation of Resident 1, indicated, a small pinkish, discolored area of resident's right forehead. Resident 1 stated she had fallen, hit her head, and had complaints of right shoulder discomfort, and nausea. On January 16, 2025, at 9:42 a.m., LVN 1 was interviewed. LVN 1 stated, Resident 1 hit her head and stated she would initiate neurochecks every 15 minutes for the first hour, every 30 minutes for the second hour and then every 4 hours for 24 hours. LVN 1 further stated neurochecks are important to assess residents for any changes in their level of consciousness. A review of Resident 1's Resident Information, dated January 17, 2025, at, 8:31 a.m., indicated, resident was admitted to the facility on , August 30, 2024, with a diagnosis of muscle weakness and history of falling. A review of Resident 1's Brief Interview for Mental Status (a cognitive assessment), dated December 9, 2024, indicated a score of 12 (moderate cognitive impairment). A review of Resident 1's SBAR (Situation, Background, Assessment, Recommendation)/COC (Change of Condition) ASSESSMENT FORM, dated January 16, 2025, indicated, .unwitnessed fall . A review of Resident 1's progress notes dated January 16, 2025, indicated, .Resident was found on the floor by CNA(Certified Nursing Assistant) .Neuro checks implemented .Patient (Resident 1) complained of headache. Will continue to monitor per doctors ordered . (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: 555383 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 555383 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/06/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Blythe Post Acute LLC 285 West Chanslor Way Blythe, CA 92225 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)