Health inspection·March 25, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a plan of care (POC) with specific goals and objectives to address the injury, for one of four sampled residents (Resident 4) when Resident 4's rib fracture was identified. This failure had the potential for Resident 4 not to receive appropriate interventions tailored to her needs. Findings: On March 3, 2025, at 8:51 a.m., an unannounced visit to the facility was conducted to investigate a facility reported incident related to an injury of unknown origin concerns. On March 3, 2025, Resident 4 ' s record was reviewed. Resident 4 was admitted to the facility on [DATE], with diagnoses which included osteomyelitis (infection of the bone) and osteoporosis (bone disease prone to fracture). A review of Resident 4 ' s History and Physical, dated February 7, 2025, indicated Resident 4 was mentally incapable of understanding. A review of Resident 4's Order Summary Report, dated February 11, 2025, indicated, .Alendronate Oral Tablet 70 MG (milligrams-unit of measurement) .Give 1 tablet by mouth in the morning every Mon (Monday) for OSTEOPOROSIS . A review of Resident 4 ' s Change of Condition, dated February 18, 2025, indicated, .Acute fractures to Right ribs 8th and 9th costochondral junction [joint between ribs and cartilage (surface that protects bones)] . On March 3, 2025, at 10:20 a.m., a concurrent interview and record review of Resident 4's records were conducted with the Licensed Vocational Nurse (LVN). The LVN stated on February 17, 2025, Resident 4 complaint of flank pain and had a change of condition that was relayed to physicianto order an X-ray (bone image). The LVN stated on the same day, the night shift nurse received a report that Resident 4 obtain a rib fracture. The LVN stated, the licensed nurse on night duty Should have been created a care plan for fracture. The LVN further stated, if care plan was not developed, the nurses would not been guided for treatment and intervention to prevent possible further injury. There was no documented evidence a care plan was initiated to addressed Resident 4's rib fracture. (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: 555613 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 555613 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/25/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Grove Care and Wellness 3401 Lemon Street Riverside, CA 92501 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)