Health inspection·April 29, 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. Based on observation, interview, and record review, the facility failed to monitor efficacy of the bed alarm to ensure it (bed alarm) was functioning for one of four sampled residents (Resident 1). This failure had the potential to result in Resident 1 having an unwitnessed fall and sustaining an injury. Findings: During an observation on 4/8/24 at 7:46 a.m. in Resident 1's room. Resident 1 was lying in bed with her eyes closed. Resident 1 had bilateral half upper side rails up, fall mats on both sides of bed, call light within reach, and room was free of clutter. Resident 1 opened her eyes slightly and then closed them again when being spoken to. Resident 1 did not say anything. During a review of Resident 1's Post Fall Review/Fall Risk Assessment (PFRFRA), dated 3/17/24, the PFRFRA indicated, 3/17/24 at 18:55 [6:55 p.m.] staff were alerted by tx [treatment] nurse [LVN 3]. Upon assessment resident [1] was laying on fall mat on side of bed closet to window; resident [1] was seated on bottom with knees bent. Resident [1] states she fell. Unwitnessed. Outcome: Major Injury. Transverse [crosswise] fracture of the right patella [bone at the front of the knee joint]. Contributing/Predisposing Factors: Forgetfulness, Impulsive Behavior/Practices, Impaired Balance, Cognitive Deficit [a loss/lacking], and Physical Deficit. Conclusion/Summary: Resident [1] attempted to get out of bed unassisted. Resident does not recall what she was trying to do at time of fall. LVN [Licensed Vocational Nurse] notes resident [1] was calling out for her mother. Resident [1] has occasional instances of attempting to get out of bed, brief was slightly wet; bed alarm was not activated. During a review of Resident 1's Plan of Care – FALLRISK, dated 3/28/22, the POCF indicated, At risk for falls and fall related injuries related to history of falls. Interventions. Effective date 3/10/23: Bed alarm when Resident [1] in bed. During a review of Resident 1's Minimum Data Set (MDS-assessment tool) dated 2/26/24, the MDS indicated, BIMS [Brief Interview for Mental Status] Summary Score 4 [severe cognitive impairment]. During a concurrent interview and record review on 4/19/24 at 1:58 p.m. with MDS Coordinator (MDSC), Resident 1's Quarterly Assessment (QA), dated 2/26/24 was reviewed. The QA indicated, Fall Risk Score 24. MDSC stated a fall risk score of 24 indicates Resident 1 is high risk for fall. During an interview on 4/8/24 at 11:53 a.m. with LVN 1, LVN 1 stated Resident 1 is dependent with staff on care. (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: 555877 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 555877 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/29/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ridgecrest Regional Transitional Care and Rehabili 1081 North China Lake Boulevard Ridgecrest, CA 93555 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)