Inspection·May 1, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed for one of three residents reviewed (Resident 2) when reports of food intake below 50% on multiple occasions were not properly communicated to nursing staff, physician (MD), and registered dietitian (RD). Residents Affected - Few This failure had the potential to negatively affect Resident 2 ' s nutritional status and overall medical status. Findings: On April 2, 2025, at 11:10 a.m. an interview was conducted with Resident 2. Resident 2 was alert and lying in bed. Resident 2 stated he did not like his diet, was not provided alternate food, and was losing weight. On April 2, 2025, at 11:40 a.m. a lunch observation was conducted with Resident 2. Resident 2 was observed sitting up to the side of the bed with full plate of food. Lunch observation showed uneaten meat, potatoes, and peas. Resident 2 stated, the meat was too salty and the vegetables were not good. Resident 2 stated, the staff were aware he would not eat it. On April 2, 2025, at 11:55 a.m. observed Certified Nursing Assistant (CNA) 1 enter the room of Resident 2, collected the tray without offering an alternative. On April 2, 2025, at 11:58 a.m. a follow up interview was conducted with Resident 2. Resident 2 stated he informed CNA 1 that he did not want to eat his meal and CNA 1 did not offer him an alternative. On April 2, 2025, at 12:01 p.m. an interview was conducted with CNA 1. CNA 1 stated if a resident refused to eat a meal, an alternative should be offered and that refusals should be reported to the charge nurse. On April 2, 2025, at 12:40 p.m. an interview was conducted with Licensed Vocational Nurse (LVN 1). LVN 1 stated she was assigned to Resident 2 today. She stated she was informed at approximately 12:35 p.m. today that Resident 2 refused his lunch meal. She stated she would document the refusal in the medical record, record the intake, and offer a supplement alternative such as a protein shake. LVN 1 stated she should be informed of refused meals no later then one hour after the refusal so alternatives could be offered but that there was no specific policy that she was aware of regarding the time frame. LVN 1 stated a progress note should be written to reflect any meals with less than 50% consumption, an alternative should be offered and the physician and kitchen made aware. (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 3 Event ID: 555740 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 555740 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Real Post Acute 1665 East Eighth Street Beaumont, 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)