Health inspection·July 3, 2024

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. An admission Record revealed the facility admitted Resident #101 on 07/26/2022. According to the admission Record, the resident had a medical history that included a diagnosis of dementia. Residents Affected - Few Resident #101's Care Plan included a focus area, initiated on 12/16/2022, that indicated the resident was at risk for falls. An intervention initiated on 05/19/2023 indicated the resident utilized a pad alarm in their bed. Another focus area, initiated on 02/07/2023, indicated Resident #101 was at risk for injury due to wandering. An intervention initiated on 03/30/2023 indicated the resident utilized a wanderguard (a type of wandering/elopement alarm) on their wheelchair. Resident #101's Progress Notes included a Health Status Note, dated 07/17/2023 at 5:08 AM, that indicated the resident's wanderguard was in place. An annual Minimum Data Set (MDS), with an Assessment Reference Date (ARD) of 07/18/2023, revealed Resident #101 had a Brief Interview for Mental Status (BIMS) score of 3, which indicated the resident had severe cognitive impairment. The MDS indicated that Resident #101 wandered during four to six days of the seven-day assessment look-back period. The MDS did not reflect the resident's use of a bed alarm or wander/elopement alarm during the seven-day look-back period. Resident #101's Progress Notes included the following entries: - a Health Status Note, dated 03/29/2024 at 6:05 AM, that indicated Resident #101's bed alarm was in place and working properly; and - an IDT [interdisciplinary team] Progress Notes- Behavior Management note, dated 04/01/2024 at 2:25 PM, that indicated Resident #101 utilized a wanderguard. A quarterly MDS, with an ARD of 04/02/2024, revealed Resident #101 had a BIMS score of 3, which indicated the resident had severe cognitive impairment. The MDS did not reflect the resident's use of a bed alarm or wander/elopement alarm during the seven-day look-back period. During an interview on 07/03/2024 at 2:17 PM, the Director of Nursing (DON) stated MDS assessments needed to be accurate. Based on interview, record review, and facility policy review, the facility failed to ensure Minimum Data Set (MDS) assessments accurately reflected the status of 1 (Resident #91) of 3 sampled residents reviewed for nutrition and 1 (Resident #101) of 1 sampled resident reviewed for dementia care. Specifically, the MDS assessments inaccurately indicated Resident #91's weight-loss was due to a (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: 555915 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 555915 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Springs Health and Rehabilitation Center 25924 Jackson Ave Murrieta, CA 92563 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)