Health inspection·January 14, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to notify the resident ' s representative, of a transfer to the Emergency Department (ED) for further evaluation of agitation for one of three residents (Resident 1). This failure resulted in Resident 1 ' s Representative not being informed of the transfer to the ED, limiting their ability to participate in the resident's medical care decisions to the extent deemed possible. Findings: On January 9, 2025, an unannounced visit was made to the facility for a quality of care issue. A review of Resident 1 ' s, Face Sheet, undated, indicated, resident was admitted to the facility on [DATE], with an admitting diagnosis of a resistive organism fungemia (fungal infection in the blood). On January 9, 2024, at 3:00 p.m., an interview was conducted with the Director of Nursing (DON). The DON stated, the document, Appointment of Personal Representative (APR), is part of the admission packet. The DON verified, this document allowed the resident to appoint a representative to be notified in case of an emergency or to make healthcare decisions on the resident's behalf if the resident is deemed confused or incapacitated. A review of Resident 1 ' s Appointment of Personal Representative, dated, December 13, 2024, untimed, indicated, . I do wish to appoint a Personal Representative . Further review of the document indicated Representative 1 was listed as resident ' s personal representative. A review of Resident 1 ' s Nursing Narrative, dated December 13, 2024, indicated, . (Resident 1) (transferred to) ED per (Doctor) . (resident) very restless/agitated . multiple attempts to crawl (Out of Bed) . Further review of Resident 1's nursing narrative revealed no documentation indicating that Resident 1's representative was notified of the transfer by RN 1. On January 9, 2025, at 5:15 p.m., a concurrent interview with the DON, and a review of Resident 1 ' s APR, Nursing Narratives, and Notification/Transfers, was conducted. The DON stated, if a resident is deemed too confused to notify their family or representative of a transfer, staff should notify the resident's appointed representative. The DON stated, the staff should document the notification in the resident ' s medical record under the Notification/Transfers section. The DON stated, Resident 1 was transferred to the ED on December 13, 2024, at 6:30 p.m., and notification of the transfer (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: 555417 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 555417 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/14/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desert Regional Medical Center D/P Snf 1150 North Indian Canyon Drive Palm Springs, CA 92262 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)