Health inspection·September 11, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility staff failed to notify the physician on 9/5/2025 when Resident 1 complained of weakness/numbness (a loss of feeling or sensation in an area of the body) to the right side the face for one of three samples Residents (Resident 1). This deficient practice had the potential to result in a lack of necessary care and treatment to Resident 1.Findings: A record review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted on [DATE] and readmitted on [DATE] and 6/28/2025 with diagnosis including chronic respiratory failure (a condition where the lungs are unable to adequately exchange oxygen), type 2 diabetes (the body's inability to process sugar), dependence on ventilator (a mechanical life-support machine that helps patients breathe), and hypertensive heart disease (a long-term condition that develops from chronic high blood pressure). A record review of Resident 1's Minimum Data Set (An assessment tool) dated 9/10/2025, indicated Resident 1 was cognitively intact. Resident 1 was dependent on staff for activities of daily living. During an interview with Resident 1 on 9/11/2025 at 10:10 a.m., Resident 1 stated that on 9/5/2025 at around 6:30 p.m., she reported to the Registered Nurse (RN 2) that she was having numbness and weakness to the right side of her face. Resident 1 stated the Registered Nurse assessed her (Resident 1), however she (RN 2) did not notify her (Resident 1) Medical Doctor. Resident 1 stated she (Resident 1) continued to have numbness to the right side of her (Resident 2) face over the weekend. Resident 1 stated she (Resident 1) complained again on 9/7/2025 to a different registered nurse (RN 1). Resident 1 stated RN 1 then proceeded to call the Medical Doctor, and she (Resident 1) was transferred to the emergency department. Resident 1 stated she does not know why it took two days for the facility to finally listen to her (Resident 1). Resident 1 stated she (Resident 1) was diagnosed in the Emergency Department with Bell's Palsy (a sudden weakness in the muscles on one half of the face). During a record review of Resident 1's Progress Notes dated 9/5/2024 at 6:40 p.m., the Progress Notes indicated Resident 1 requested a Registered Nurse (RN 2) present in her (Resident 1) room and stated she (Resident 1) feels like her mouth is tilting to one side. RN 2 assessed Resident 1 for any signs of stroke (damage to the brain from interruption of blood supply) but noted none at the time. RN 2 educated Resident 1 on signs and symptoms of stroke. RN 2 asked Resident 1 to stay calm and relax for a better assessment to be done. Resident 1 was reassessed after 5 to 10 minutes when Resident 1 was calm and no abnormalities noted. During an interview with Registered Nurse (RN 2) on 9/11/2025 at 1:57 p.m., RN 2 stated, she was called to assess Resident 1. RN 2 stated when she went into Resident 2's room, she noted Resident 1 crying, and she (Resident 1) stated she was experiencing numbness and weakness to the right side of her face. RN 2 stated she did not notice any weakness to Resident 1's right side of the face, and she did not notify Resident 1's Medical Doctor. RN 2 stated, she later realized that she should have called the Medical Doctor, but she failed to do so. During an interview with Assistant Director of Nurses (ADON) on (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 3 Event ID: 555904 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 555904 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Ellison John Transitional Care Center 43830 10th Street West Lancaster, CA 93534 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)