Health 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. Page 1 of 3 555740 555740 05/01/2025 Vista Real Post Acute 1665 East Eighth Street Beaumont, CA 92223

F 0684 Level of Harm - Minimal harm or potential for actual harm On April 2, 2025, Resident 2 ' s record was reviewed. Resident 2 was admitted to the facility on [DATE], with diagnosis which included Schizophrenia (mental health disorder). A review of Resident 2 ' s History and Physical Examination , dated January 17, 2025, indicated has the capacity to understand and make decisions. Residents Affected - Few A review of Resident 2's Minimum Data Set (an assessment tool), dated January 27, 2025, indicated Resident 2 had a Brief Interview of Mental Status (a cognitive screening tool used to assess the mental state of residents) Score of 12 (moderately impaired). A review of the document titled, special diets undated, indicated .special diets .regular .notes .resident likes grilled cheese if he refuses meal .alerts (blank) .dislikes (blank). A review of the documents titled Activity/Residents Requests indicated, there was no documented evidence Resident 2 received an alternative menu item during the breakfast and lunch meal percentage intake found to be less then 50%. A review of the IDT weekly weight nutrition note dated February 19, 2025 indicated, .current weight: 134 lbs (pounds-a unit of measurement) .IBWR (ideal body weight) 139 -166 lbs . A review of Resident 2 ' s intake and output for the month of March 2025 indicated the following: - March 1, 2025, amount eaten 25%-50% lunch. - March 4, 2025, amount eaten 25%-50% lunch. - March 10, 2025, amount eaten 25%-50% lunch. - March 17, 2025, amount eaten 25%-50% breakfast. - March 18, 2025, amount eaten 0-25% breakfast and lunch - March 25, 2025, amount eaten 0-25% lunch. - March 28, 2025, amount eaten 25%-50% lunch. - March 29, 2025, amount eaten 25%-50% lunch . A further review of Resident 2's medical record, indicated, there was no documentation the meal percentage below 50% was reported to the nurse, the medical doctor (MD), or the Registered Dietitian (RD). In addition, there was no documented evidence a care plan was developed to provide interventions regarding Resident 2's meal refusals. On April 2, 2025, at 4:17 p.m., an interview and record review were conducted with the Director of Nursing (DON). The DON stated, she was not aware that Resident 2 consumed less than 50% on March 1, 4, 6, 10, 17, 18, 25, 28, and 29, 2025, and the nurses should have documented the refusals, offered alternatives, and alerted her. The DON stated, she should have been made aware by the nurses and a meeting should have been conducted to provide interventions to prevent weight loss. The DON stated, the RD was present in the facility every Wednesday and during the monthly IDT meetings. 555740 Page 2 of 3 555740 05/01/2025 Vista Real Post Acute 1665 East Eighth Street Beaumont, CA 92223

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On April 7, 2025, at 10:39 a.m. an interview and record review was conducted with the Registered Dietitian (RD). The RD stated she was not made aware of Resident 2's inadequate intakes on March 1, 4, 6, 10, 17, 18, 25, 28, and 29, 2025. The RD stated she was present in the facility every Wednesday of the week and during the IDT monthly weight variance meetings. The RD stated she was not made aware of any preference changes or refusals prior to April 2, 2025. The RD further stated she could have provided prevention interventions earlier if informed. A review of the facility policy and procedure titled, Food and Nutrition Services dated 2001, indicated, Each resident is provided with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs, taking into consideration the preferences of each resident .Nursing personnel .will evaluate (and document as indicated) food and fluid intake of residents with, or at risk for, significant nutritional problems .variations from usual eating or intake patterns will be recorded in the resident ' s medical record and brought to the attention of the nurse . a nurse will evaluate the significance of such information and report it, as indicated, to the attending physician and dietitian . 555740 Page 3 of 3