Inspection·September 9, 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 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to monitor emotional distress after an abuse and neglect allegation, for one of three residents reviewed (Resident 1), when the resident alleged abuse and neglect by the nursing staff at the General Acute Hospital (GACH). This failure could result in staff not recognizing Resident 1's emotional distress and being unable to provide necessary psychosocial support. Findings:On September 9, 2025, at 11:14 a.m., an unannounced visit was conducted at the facility to investigateOn September 9, 2025, Resident 1's record was reviewed. Resident 1 was admitted to the facility on [DATE], with diagnoses which included postlaminectomy syndrome (a condition characterized by persistent or recurrent pain and other symptoms after a laminectomy surgery [a surgical procedure that involves removing part or all of the lamina, which are the bony arches that cover the spinal cord]), diabetes mellitus (abnormal blood sugar), and fibromyalga (a chronic condition characterized by widespread pain, fatigue, and other symptoms). A review of Resident 1's Progress Notes, dated July 29, 2025, at 10:28 a.m., indicated, .admission H&P (History and Physical).Patient has capacity to make medical decisions.A review of Resident 1's Progress Notes, dated August 18, 2025, indicated, .spoke to resident TX (Treatment) Nurse regarding her report to Tx Nurse about feeling neglected in the emergency room at the hospital over the weekend. Resident stated she felt the nurse in the emergency room at (name of hospital) was very dismissive towards her and did not give her the care that she needed while she was there.Further review of Resident 1's record, indicated there was not follow up monitoring of resident's psychosocial condition after the resident reported the allegation against the GACH.On September 9, 2025, at 2:48 p.m., during an interview conducted with Licensed Vocational Nurse (LVN) 1, LVN 1 stated residents were to be monitored for 72 hours after a change of condition (COC).On September 9, 2025, at 5:14 p.m., during an interview conducted with the Administrator (ADM), the ADM stated Resident 1 reported an allegation of neglect while at the emergency room of the GACH. The ADM stated 72-hour monitoring should have been implemented and documented when Resident 1 reported an allegation of neglect.A review of the facility's policy and procedure titled, Change in a Resident's Condition or Status, dated May 2017, indicated, .The nurse will notify the resident's Attending Physician or physician on call when there has been a(an).significant change in the resident's physical/emotional/mental condition.The nurse will record in the resident's medical record information relative to changes in the resident's medical/mental condition or status. Residents Affected - Few 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: 555404 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 555404 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riverside Village Healthcare Center 17040 Arnold Dr. Riverside, CA 92518 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)