Health inspection·January 29, 2025

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Allow resident to participate in the development and implementation of his or her person-centered plan of care. Based on interview and record review, the facility failed to protect the right of one of three sampled residents (Resident 1) to participate in the resident's treatment when the facility failed to give Resident 1's Pramipexole Dihydrochloride (medication used to treat Parkinson's disease [a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination]) at Resident 1's requested time. This failure had the potential for Resident 1 to experience an increase in tremors (involuntary, rhythmic shaking movements that can affect various parts of the body). Findings: During a review of Resident 1's admission Record (AR), the AR indicated the facility admitted Resident 1 on 1/20/2025, with diagnoses including Parkinson's disease, chronic obstructive pulmonary disease (COPD, a group of diseases that cause airflow blockage and breathing-related problems), and need for assistance with personal care. During a review of Resident 1's physician order (PO) dated 1/20/2025, the PO indicated an order for Pramipexole Dihydrochloride oral tablet one (1) milligrams (mg, unit of measurement), give 1 tablet by mouth three times a day for Parkinson's disease. During a review of Resident 1's History and Physical Examination (H&P), dated 1/21/2025, the H&P indicated Resident 1 had the capacity to understand and make decisions. During an interview on 1/28/2025 at 11:05 a.m. with Resident 1, Resident 1 stated her Parkinson's medication (Pramipexole Dihydrochloride) was being given to Resident 1 daily at 9 a.m. Resident 1 stated Resident 1 wanted the medication to be given to her at 7:30 a.m. because the medication being given at that time helped Resident 1 to not shake from her Parkinson's disease. Resident 1 stated Resident 1 spoke to facility staff (unidentified) about changing the medication time from 9 a.m. to 7:30 a.m. but facility staff continued to give Resident 1 the medication at 9 a.m. Resident 1 stated the medication administration time was finally changed to 7:30 a.m. as Resident 1 requested on 1/27/2025. During a concurrent interview and record review on 1/29/2025 at 10:15 a.m. with the Assistant Director of Nursing (ADON), Resident 1's Medication Administration Record (MAR), dated January 2025 and Resident 2's IDT (Interdisciplinary Team, a group of health care professionals with various areas of expertise who work together toward the goals of the resident) Care Conference Notes (IDT Notes), dated 1/21/2025 were reviewed. The IDT Notes indicated on 1/21/2025, the IDT met with Resident 1 (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 4 Event ID: 555416 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 555416 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Glendora Canyon Transitional Care Unit 401 W. Ada Ave. Glendora, CA 91741 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)