Inspection·September 15, 2023

F 0620 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, for one (Resident 1) of three residents, the facility failed to admit Resident 1 to the facility when a bed was not made readily available for an arranged admission on [DATE]. The facility's failure to make a bed readily available for a pre-arranged admission resulted in a denial of Resident 1's entry and admission on [DATE]. Findings: On August 9, 2023, at 9:30 a.m., an unannounced visit was conducted to investigate an issue regarding Admission, Transfer and Discharge Rights. On August 9, 2023, at 9:30 a.m., the Director of Nursing (DON) and Administrator (ADM) were interviewed. The DON indicated that Resident 1was denied admission into the facility on July 20, 2023, when he showed up positive for COVID -19 infection on a spot testing conducted upon arrival to the facility. The DON indicated they do not have a bed available to quarantine (isolation precaution purposes) the resident to prevent spread of infection. DON was unable to provide for documented evidence the hospital was informed of the need for COVID testing prior to Resident 1's entry in the facility. On August 22, 2023, at 12:30 p.m., a concurrent interview and record review was conducted with the Infection Preventionist Nurse (IPN). IPN stated that on July 20, 2023, they have not given the hospital prior notice to do COVID Testing on the resident before he was sent to the facility. IPN stated positive COVID -19 infection does not disqualify a resident for admission into the facility. IPN stated she made the call that day to send the resident back to the hospital because she did not believe they have a room available for isolation in the facility. IPN stated bed capacity was 54, and census that day was 40. IPN stated there should be 14 beds readily available for incoming resident admission that day but she was not aware that rooms [ROOM NUMBER] were not officially suspended for resident use. IPN stated the staff in the facility were trained and are capable to handle COVID -19 positive residents. The IPN indicated they should have made bed available for immediate occupancy on July 20, 2023. On August 22, 2023, at 1 p.m., the ADM was interviewed. The ADM verified they have 54 certified beds in the facility for occupancy. DON verified the bed capacity for resident use was 54 bed and they have not requested that bed be suspended for any other purposes than patient use. DON verified they are capable of handling residents with COVID -19 infections and that they should have made a bed (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: 555463 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 555463 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/15/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Village Healthcare Center 2400 West Acacia Avenue Hemet, CA 92545 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)