Health inspection·November 5, 2024

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure an environment free of accident hazard was provided, for one of three residents (Resident 1) reviewed for elopement (resident leaves the facility without authorization or supervision necessary for his safety) when the door alarm was not activated. This failure had the potential for Resident 1 to be able to leave the facility undetected, which could lead to repeated elopement and have subsequently result in accidents, injuries or even death to the resident. Findings: On November 5, 2024, at 9 a.m., an unannounced visit was conducted at the facility to investigate an incident of elopement. On November 5, 2024, at 9:30 a.m., during a concurrent observation and interview with the Director of Staff Development (DSD) in hallway 200, the exit door was observed with a red alarm equipment attached to the inner side of the door. The door alarm was tested by opening the door and did not hear any alarm sound come off. The DSD stated the door alarm was off and should have been turned on. The DSD further stated she forgot to activate the alarm this morning when she used to enter the facility. The DSD stateed the alarm on the exit door in hallway 200 should have been checked and the alarm should be turned on. The DSD stated if the alarm was not armed, it could result to the resident to go out without staff noticing them, and could lead to accident or injuries. On November 5, 2024, at 9:37 a.m., during an interview with Registered Nurse (RN) 1. RN 1 stated the door in hallway 200 was used for emergency door for paramedics and for staff as well. RN 1 stated the door alarm should had been turn on whether it was use as entrance or exit by the staff. RN 1 further stated if the door alarm was off, there was a potential for resident to get off the door and could leave the facility undetected. On November 5, 2024, at 9:50 a.m., during a concurrent observation and interview with Resident 1. Resident 1 was sitting in a folding chair outside his room with a sitter beside him. Resident 1 stated he loved to walk around, and he wants to look for the door to go out to see and feed his dog. Resident 1 further stated I could probably use that door. On November 5, 2024, Resident 1 ' s admission RECORD, was reviewed. Resident 1 was admitted on [DATE], with diagnoses which included altered mental status, unspecified psychosis (mental illness). (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: 555742 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 555742 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Desert Mountain Care Center 47-763 Monroe Avenue Indio, CA 92201 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)