F 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or
her rights.
Based on observation, interview, and record review, the facility failed to ensure resident was treated with
respect and dignity for one resident (Resident 1) when the facility staff spoke to Resident 1 using language
and tone as if one might address a child and refused Resident 1 to receive a shower at his preferred
time.This failure resulted in Resident 1 feeling put down and embarrassed which could potentially affect his
care from his lack of trust or doubt with the facility staff to participate in treatment plan.Findings:During a
review of a Medical Doctor (MD) Progress Note, dated August 27, 2024, the MD progress note indicated
Resident 1 has history of congestive heart failure (a serious condition in which the heart doesn't pump
blood through the body as efficiently as it should), seizure disorder (a sudden burst of electrical activity in
the brain and can cause changes in behavior, movements, feelings and levels of consciousness), stroke (a
serious medical emergency that happens when blood flow to the brain is interrupted, either by a blockage
or a rupture of a blood vessel), hypothyroidism (when the thyroid gland isn't producing enough thyroid
hormones and many bodily functions slow down), and hypertension (when the force of the blood pushing
on the blood vessel walls is too high and the heart has to pump harder). During a review of the facility's
document title, Report of Suspected Dependent Adult/Elder Abuse (SOC 341-a form that the facility is
required to report suspected abuse), dated June 11, 2025, the SOC 341 indicated that there was potential
for verbal abuse from a Certified Nurse Assistant (CNA1) towards Resident 1. The SOC 341 also indicated
that a CNA spoke to a resident in a belittling and demeaning manner, using language and tone comparable
to how one might address a child. This occurred after the resident requested a shower in the evening,
having declined one earlier in the day.During an interview on June 20, 2025, at 10:51 AM, with Resident 1,
Resident 1 stated I wanted a shower, and [CNA1] was Snooty. [CNA1] said I tried to get you to the shower
earlier and I said I'm sorry. I just didn't want to shower in am and would rather know what I did for [CNA1] to
yell at me like that. [CNA1] came down like a cat out hell. She was mean and vulgar. Resident 1 stated that
CNA1 yelled at him in front of the facility staff and other residents which made him feel not too good.During
an interview on June 20, 2025, at 11:52 AM, with RN1, RN1 stated Resident 1 did not want to shower at
the scheduled time and CNA1 responded in a very unprofessional tone and was brazen with him.During an
interview on June 20, 2025, at 12:17 PM, with the Director of Nursing (DON), the DON stated that Resident
1 live here, and CNA1 was rude and didn't need to be.During an interview on July 7, 2025, at 11:22 AM,
with CNA2, CNA2 stated Resident 1 asked about a shower and CNA1 scolded [Resident 1] like a child
because he was asking for a shower and CNA1 asked 'why are you asking me now, it's late.' CNA2 further
stated It was disturbing. It didn't sit right. CNA2 added, He was aware of her behavior, and he asked, 'why
are you talking to me like that'. CNA2 stated, He was completely silent after that. I think he got embarrassed
and left [the area]. It was embarrassing to him because other people were around. I wouldn't want to be
treated like putting me down with others around.During a concurrent interview and record review
(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:
555468
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
555468
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
07/07/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Bear Valley Community Hospital
41870 Garstin Rd
Big Bear Lake, CA 92315
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 0550
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
on July 7, 2025, at 11:42 AM, with the Assistant Director of Nursing (ADON) and DON, the facility's policy
and procedure (P&P) titled, Resident Rights, undated, was reviewed. The P&P indicated, POLICY: [The
facility] will assure that all residents are treated with respect and dignity in a manner and environment that
promotes their quality of life while promoting their right to self-determination whereby their care choices are
respected . PROCEDURE: .3. The right to be assisted by all staff in maintaining and enhancing their
self-esteem and self-worth .15.The right to choose their own schedule and have their needs
accommodated in relation to: .15.3. Their bathing times and schedule . The ADON and DON acknowledged
that the right to be treated with dignity and respect as well as the right to make his own schedule was not
followed.
Event ID:
Facility ID:
555468
If continuation sheet
Page 2 of 2