Health inspection·February 15, 2024

F 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. 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 to provide the necessary care and treatment to a resident's (1) identified skin issues (redness of the buttocks), for one of three sampled residents, when Resident 1's physician was not informed of the resident's skin condition during admission to the facility. Residents Affected - Few The delayed care and treatment to Resident 1's skin issues had the potential to worsen Resident 1's skin condition. Findings: On 2/9/24, an unannounced onsite at the facility was conducted related to a complaint on quality of care. During a review of the facility's admission Record, dated 12/31/23, the admission Record indicated Resident 1 was admitted to the facility, with diagnoses which included generalized body weakness, dementia (inability to think, remember and reason), hemiplegia (paralysis that affect one side of the body), and hemiparesis (weakness or inability to move on one side of the body). During a review of Resident 1's minimum data set (MDS, an assessment tool), dated 1/2/24, indicated Resident 1's brief interview for mental status (BIMS, ability to recall) score was 7, which meant Resident 1's cognition was severely impaired. The functional abilities section of the MDS indicated Resident 1 required maximum assistance when repositioning in bed. During a review of Resident 1's undated acute care hospital (ACH) record, indicated Resident 1 had no skin issues [no rashes or ecchymosis - bruises]. During a review of Resident 1's skin measurement observation form completed by Licensed Nurse (LN) 1 dated 1/14/24, indicated LN 1 documented Resident 1 had moisture associated skin damage (MASD, caused by prolonged exposure to various sources of moisture, including urine or stool, perspiration, wound exudate, mucus, saliva, and their contents) at the buttocks. During a review of Resident 1's Treatment Administration Record (TAR) for January 2024, indicated Resident 1 started receiving treatment of her buttocks on 1/2/24. During a joint observation of Resident 1 and an interview with Resident 1's personal caregiver (PC) on 2/9/24 at 12:13 P.M., PC stated she came to the facility every day. PC stated Resident 1 had some redness on her buttocks. PC opened Resident 1's incontinence brief and showed Resident 1's (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: 555870 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 555870 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/15/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bella Vista Health Center 7922 Palm Street Lemon Grove, CA 91945 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)