Health inspection·June 13, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some A review of the MAR for the month of April 2025, indicated the 9 am dose of vancomycin was not administered on April 28 and April 29, 2025. The MAR indicated the medication was unavailable on April 28, 2025. On May 2, 2025, at 2:17 p.m., an interview and concurrent record review was conducted with the Registered Nurse (RN). The RN stated Residents 3's and Resident 7's MAR indicated late, missed, and early administration. The RN stated residents should not have missed or late medication doses. The RN stated if unable to administer a medication or a dose was missed the process is to call the physician, notify the physician of the issue and get orders to adjust the time. On May 2, 2025, at 4:04 p.m. an interview and concurrent record review was conducted with the Director of Nursing (DON). The DON stated there was no documented evidence that the antibiotics cefazolin and vancomycin were given on time. The DON stated the MAR should reflect the administered time of a medication not the charted time of a medication. The DON stated medication should be charted accurately and timely. The DON stated the physician, and the pharmacy should have been notified that a resident medication was not in the facility to administer. A review of the facility policy and procedure titled, Medication Administration General Guidelines, dated January 2021, indicated, .Medications are administered as prescribed .good nursing principles and practices .Medications are administered in accordance with written orders of the prescriber .if necessary the nurse contacts the prescriber for clarification .Medications are administered within 60 minutes of scheduled time .individuals who administers the medication dose, records the administration on the resident's MAR immediately following the medication being given . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555403 If continuation sheet Page 2 of 5 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 555403 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Monterey Palms Health Care Center 44610 Monterey Avenue Palm Desert, CA 92260 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure medical records were maintained in accordance with the accepted professional standards and practices when three of four sampled residents' (Resident 3, Resident 5, and Resident 6) medication administrations were not accurately documented. This failure increased the risk for medication errors which could negatively impact Residents 3, 5, and 6's health condition. Findings: On April 29, 2025, at 1:20 p.m., Resident 3 was interviewed. Resident 3 was alert and oriented. Resident 3 stated he would at times receive his antibiotic late or early. A review of Resident 3's admission record indicated the resident was admitted to the facility on [DATE], with diagnoses which included bacteremia (bacteria in blood), diabetes (high blood sugar), and hypertension (high blood pressure). A review of the physician order dated April 11, 2025, indicated, cefazolin 2 (grams) gm/(milliliter) mL (gm/mL measure of metric) administer intravenous (in the vein) every 8 hours at 7:00 am, 3:00 pm, and 11:00 pm for bacteria in the blood. A review of Resident 3's Medication Administration Record (MAR) for the month of April 2025, indicated the following: a. April 12, 2025, 7 a.m. dose of cefazolin was charted as administered at 8:04 a.m., with the comment that the medication was given on time; b. April 14, 2025, 7 a.m. dose of cefazolin was charted as administered at 9:16 a.m., with the comment that medication administration was charted late; c. April 15, 2025, 7 a.m., dose of cefazolin was charted as administered at 9:35 a.m., with the comment that medication administration was charted late; d. April 16, 2025, 7 a.m. dose of cefazolin was charted as administered at 8:27 a.m., with the comment that medication administration was charted late; e. April 17, 2025, 7 a.m. dose of cefazolin was charted as administered at 9:39 a.m., with the comment that medication administration was charted late; f. April 18, 2025, 7 a.m. dose of cefazolin was charted as administered at 9:08 a.m., with the comment that medication administration was charted late; g. April 21, 2025, 7 a.m. dose of cefazolin was charted as administered at 9:30 a.m., with the comment that medication administration was charted late; h. April 22, 2025, 7 a.m. dose of cefazolin was charted as administered at 9:29 a.m., with the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555403 If continuation sheet Page 3 of 5 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 555403 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Monterey Palms Health Care Center 44610 Monterey Avenue Palm Desert, CA 92260 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 0842 comment that medication administration was charted late; Level of Harm - Minimal harm or potential for actual harm i. April 23, 2025, 7 a.m. dose of cefazolin was charted as administered at 8:12 a.m., with the comment that medication administration was charted late; Residents Affected - Some j. April 24, 2025, 7 a.m. dose of cefazolin was charted as administered at 8:41 a.m., with the comment that medication administration was charted late; k. April 25, 2025, 7 a.m. dose of cefazolin was charted as administered at 8:49 a.m., with the comment that medication administration was charted late; and l. April 28, 2025, 7 a.m. dose of cefazolin was charted as administered at 10:39 a.m., with the comment that medication administration was charted late. A review of Resident 5's admission record indicated the resident was admitted to the facility on [DATE], with diagnoses which included septicemia (bacteria in blood), congestive heart failure, and cerebral vascular attack (stroke). A review of the physician order dated April 25, 2025, indicated for Resident 5 to be given ceftriaxone 2 gm/50 mL intravenously, daily at 9:00 a.m. for sepsis. A review of the MAR for the month of April 2025, indicated the 9 am dose of ceftriaxone dated April 28, 2025, was charted as administered at 10:53 a.m. and on April 29, 2025, charted as administered at 10:08 a.m. A review of Resident 6's admission record indicated the resident was admitted to the facility on [DATE], with diagnoses which included Crohn's disease (inflammatory disease of the intestines), ileocecal resection (removal of small intestine), ileostomy (artificial opening in the stomach wall). A review of the physician order dated May 1, 2025, indicated for Resident 6 to be given fluconazole 200 mg/100 mL intravenously daily at 9:00 p.m. for abdominal abscess with JP drain (stomach pus drained through a closed suction drain). A review of the MAR for the month of May 2025, indicated the 9 pm dose of fluconazole dated May 1, 2025, indicated the medication administration was charted at 10:26 p.m. On May 2, 2025, at 2:17 p.m. an interview and concurrent record review was conducted with the Registered Nurse (RN). The RN stated Residents 3, 5, and 6's MARs indicated late administrations doses on time but documented late. The RN stated documentation in the medication administrations should have done accurately and timely. On May 2, 2025, at 4:04 p.m. an interview and concurrent record review was conducted with the Director of Nursing (DON). The DON stated the MAR should reflect the administered time of a medication not the charted time of a medication. The DON stated medication should be charted accurately and timely. A review of the facility policy and procedure titled Charting, indicated, .Entries should reflect factual statements .be accurate .right date/time .all entries are considered final upon completion and may not be altered or removed .altering any portion of the medical record .willful acts of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555403 If continuation sheet Page 4 of 5 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 555403 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Monterey Palms Health Care Center 44610 Monterey Avenue Palm Desert, CA 92260 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 0842 falsification entries should never be post-dated/timed . Level of Harm - Minimal harm or potential for actual harm A review of the facility policy and procedure titled, Medication Administration General Guidelines, dated January 2021, indicated, .Medications are administered as prescribed .good nursing principles and practices .Medications are administered in accordance with written orders of the prescriber .if necessary the nurse contacts the prescriber for clarification .Medications are administered within 60 minutes of scheduled time .individuals who administers the medication dose, records the administration on the resident's MAR immediately following the medication being given . Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 555403 If continuation sheet Page 5 of 5