Health inspection·February 11, 2026

F 0604 Ensure that each resident is free from the use of physical restraints, unless needed for medical treatment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility P&P review, the facility failed to ensure one of five sampled residents (Resident 1) reviewed for restraints was free from physical restraints. * The facility failed to ensure the use of physical restraints was based upon identified medical symptoms. Additionally, the facility failed to conduct an assessment to determine the existence of medical symptoms, attempt less restrictive measures, and develop a care plan for Resident 1's bilateral hand mittens. * The facility failed to inform Resident 1's responsible party of the potential risks and benefits and obtain consent for the use of Resident 1's bilateral hand mittens. * The failed to document the length of time the restraint was anticipated to be used, failed to identify who could apply the restraint, when the restraint could be applied and how the restraint was to be used. In addition, the facility failed to document Resident 1's circulation, mobility, and skin when bilateral mittens were used. These failures posed the risk of compromising the resident's independence and psychosocial well-being.Findings: Review of the facility's P&P titled Use of Restraints, revised on 4/2017 showed the following:- physical restraints are defined as any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's body that the individual cannot move easily, which restricts freedom of movement or restricts normal access to one's body;examples of devices that are/may be considered physical restraints include leg restraints, arm restraints, hand mitts, soft ties or vest, wheelchair safety bars, geri-chairs, and lap cushions, and trays that the resident cannot remove;- restraints may only be used if/when the resident has a specific medical symptom that cannot be addressed by another less restrictive intervention and a restraint is required to treat the medical symptom, protect the resident's safety, and help resident attain the highest level of his/her physical or psychological well-being;- prior to placing a resident in restraints, there shall be a pre-restraining assessment and review to determine the need for restraints. The assessment shall be used to determine possible underlying causes of the problematic medical symptoms and to determine if there are less restrictive interventions that may improve the symptoms;- treatment restraints may be used for the protection of the resident during treatment and diagnostic procedures if the resident and/or representative has consented to the treatment or procedure and the use of treatment restraints;- restraints shall only be used upon the written order of a physician and after obtaining consent from the resident and/or representative. The order shall include the specific reason for the resident as it relates to the resident's medical symptom, how the restraint will be used to benefit the resident's medical symptom, and the type of restraint and period for the use of the restraint;- the following safety guidelines shall be implemented and documented while a resident is in restraints. The opportunity for motion and exercise is provided for a period of not less than 10 minutes during each two hours in which restraints are employed;- restraints and/or surrogate/sponsor shall be informed about the potential risks and benefits of all options under consideration, Residents Affected - Few (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 5 Event ID: 555751 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 555751 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/11/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Newport Subacute Healthcare Center 2570 Newport Blvd Costa Mesa, CA 92627 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)