Health inspection·July 30, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview, and record review, the facility failed to provide a comfortable environment for the residents, when the temperature level for one of the four residents' rooms and in the facility hallway was above 81 degrees Fahrenheit (°F -temperature scale). This failure had the potential to cause discomfort, irritability, sleep disruption, and could lead to health problems. Findings: On July 9, 2024, at 4:15 p.m., an unannounced visit to the facility was conducted to investigate a physical environment issue. On July 9, 2024, at 4:20 p.m., the Resident Representative (RR) was interviewed. The RR stated, on July 6, 2024, the air conditioning was not functioning and the staff had indicated it would be fixed. The RR, who visits the facility daily, stated, facility was hot. The RR stated, last night Resident A woke up soaking wet. The RR stated, the facility air conditioning unit was in poor condition. On July 9, 2024, at 4:30 p.m., the Maintenance Director (MD) was interviewed. The MD stated he was unaware that the air conditioning was not working last Saturday (July 6, 2024). The MD stated he checked the airconditioning this morning and found the airconditioning system lacking sufficient freon (essential for cooling process).The MD further stated the regular comfortable temperature ranges from 71- 81°F (Fahrenheit). On July 9, 2024, at 4:45 p.m., the Maintenance Assistant (MA) was interviewed. The MA stated, the staff did not report to him on Saturday (July 6, 2024) that the airconditioning was not working. The MA stated the staff should have called him. On July 9, 2024, at 5:15 p.m., a concurrent observation of the hallway and Resident A's room was conducted with the MD. The MD stated, the temperature for the hallway and Resident A's room was 83°F. The MD further stated the temperature was high. On July 9, 2024, at 5:40 p.m., the Certified Nursing Assistant (CNA) was interviewed. The CNA stated he would report to Maintenance immediately if the facility temperature was hot. The CNA stated he would ensure the resident's comfort. On July 9, 2024, at 6:15 p.m., a concurrent observation and interview with the DON were conducted. The DON stated, the temperature in the hallway was 83°F. The DON stated the comfortable (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: 555492 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 555492 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/30/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oak Glen Post Acute 9246 Avenida Miravilla Cherry Valley, CA 92223 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)