Health inspection·March 29, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure two of 25 rooms were clean, sanitary, and homelike when damage was observed on walls and ceiling of rooms [ROOM NUMBERS]. These failures created an environment that was not clean, sanitary, and homelike for residents who reside in room [ROOM NUMBER] and 107. Finding: During an observation on March 25,2024, at 4:10 PM, in resident's room [ROOM NUMBER], an entire section of wooden trim was observed to be missing along the back wall and the headboard wall creating an open area of exposed unpainted dry wall along the length of the room. During an observation on March 25, 2024, at 4:15 PM, in resident's room [ROOM NUMBER], an approximate 2 foot by 4-foot section of wall and ceiling and windowsill was found to be unpainted with exposed drywall and chipping paint. During a concurrent observation, and interview, on March 25, 2024, at 4:30 PM, with the facility Infection Control Practitioner 1 (ICP1), in room [ROOM NUMBER], the damaged section of wall, ceiling and windowsill were observed. ICP 1 stated, the room is not in good repair, she states she would not find this acceptable if this was my home. ICP 1 further stated she was aware of the damage in room [ROOM NUMBER] as well and had put in a work order in today to have it fixed properly. During a review of the facility's policy and procedure (P&P) titled, Homelike Environment, dated March 13, 2024, the P&P indicated, The facility staff and management maximizes to the extent possible, the characteristics of the facility that reflect personalized, homelike setting. These characteristics include a. clean, sanitary and orderly environment. 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 4 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 03/29/2024 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)