Health inspection·May 23, 2025

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure services provided meet professional standards of practice, for one of one resident reviewed (Resident 39), when the Licensed Vocational Nurse (LVN) did not check the NGT (nasogastric tube - a flexible tube inserted through the nose and down the throat into the stomach) placement prior to medication administration. Residents Affected - Few This failure had the potential for Resident 39 to develop aspiration pneumonia (a lung infection that occurs when food, liquid, or objects are inhaled into the lungs causing inflammation and fluid build-up). Findings: On May 21, 2025, at 11:23 a.m., a concurrent medication administration observation and interview was conducted with the LVN. The LVN was observed to prepare Resident 39's medications and checked the arm band to verify her identity. The LVN stopped the feeding, attached a 60 ml (milliliter - a unit of measurement) syringe into the NGT and tried to aspirate for gastric residual (stomach contents). There was no gastric residual observed after the LVN aspirated from the NGT. The LVN was observed to pour the medications into the 60 ml syringe. The LVN was asked prior to administering the medication if she checked the NGT placement. The LVN stated there was no need to check the tube placement since Resident 39 had NGT and not a G-tube (gastrostomy tube - a medical device inserted through the abdominal wall directly into the stomach, used to provide enteral nutrition or medications). The LVN was instructed to check NGT placement prior to medication administration. Resident 39's record was reviewed. Resident 39 was admitted to the facility on [DATE], with diagnoses which included post partum cardiac arrest (a sudden, unexpected loss of heart function, breathing and consciousness after giving birth). Resident 39's care plan, dated January 9, 2025, indicated, .Resident has NGT .The resident will be free of aspiration .Check for tube placement and gastric contents/residual volume per facility protocol . On May 21, 2025, at 3:18 p.m., the Director of Nursing (DON) was interviewed. The DON stated all licensed nurses (LVN or Registered Nurse) were expected to check tube placement, NGT or G-tube prior to administering tube feedings and/or medications. The DON stated placement verification of the tube could be done by aspirating for gastric residual. He stated if there was gastric residual, the tube was in place. He stated if there was no gastric residual, the licensed nurse should slowly inject a small amount of air using a 60 ml syringe into the tube and listen with the use of a stethoscope for the swooshing sound to verify placement. The DON stated the LVN should have checked the NGT placement by slowly injecting a small amount of air into the tube and listened to the swooshing sound before administering medications. (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 5 Event ID: 555390 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 555390 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Corona Regional Medical Center D/P Snf 730 Magnolia Avenue Corona, CA 92879 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)