Health inspection·January 25, 2024

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to promptly report an injury of unknown origin to the California Department of Public Health (CDPH) in accordance with the facility's policy, for one of three residents (Resident 1). This failure had the potential for an injury of unknown origin to go uninvestigated and unreported thereby increasing the chances of harm to Resident 1. Findings: An unannounced visit was made to the facility on January 25, 2024, at 9:50 AM, to investigate a complaint regarding Injury of Unknown Origin. During a review of residents ' 1 ' s admission Record (General Demographics), the document indicated resident 1 was admitted to the facility on [DATE], with a diagnosis to include Alzheimer ' s Disease (A progressive disease that destroys memory and other important mental functions), Epilepsy (A disorder in which nerve cell activity in the brain is disturbed, causing seizures), Disorder of bone density and structure. During a review of resident 1 ' s progress notes (the records nurses and doctors keep during a patient's hospitalization) on January 25, 2024, at 11:20 AM, the record dated January 10, 2024, at 11:23 PM, it indicated, Resident found lying on the floor on the right side of bed. With legs still up on bed. Skin assessment performed by writer. Resident has bruising to the left upper shoulder. No injuries reported to physician. During a review of resident 1 ' s progress notes on January 25, 2024, at 11:20 AM, the record dated January 14, 2024, at 8:21 PM, it indicates received x-ray results for this resident of the left shoulder s/p (status post) fall occurring January 11, 2024. Results sent to MD (doctor) for review. Doctor ordered for resident to be sent to ER (emergency room) for further follow-up. MD requesting CT(computerized tomography) scan to be completed at ER. Orders carried out. DON (director of nursing) made aware of transfer and agree. Daughter in law, notified of transfer and clinical situation. During an interview of resident 1, Resident was lying down. Resident is Spanish speaking and answers only yes and no. Resident has Alzheimer ' s and dementia. Resident is unable to communicate or answer questions. Resident bed is in low position and has a fall mattress next to the bed. Call light within reach. (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: 555772 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 555772 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Joshua Tree Post Acute 8515 Cholla Ave Yucca Valley, CA 92284 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)