Health inspection·January 21, 2025

F 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure pain medications were administered as ordered by the physician, for one of three residents (Resident A). Residents Affected - Few This failure had the potential for Resident A's pain not be managed and affect overall health condition. Findings: On January 2, 2025, at 11:30 a.m., an unannounced visit to the facility was conducted to investigate an allegation of abuse. On January 2, 2025, a review of Resident A's medical record was conducted. Resident A was admitted to the facility on [DATE], with diagnoses which included atherosclerotic (a buildup of fats, cholesterol, and other substances in and on the artery walls) heart disease and polyneuropathy (a condition where multiple peripheral nerves throughout the body become damaged or malfunction). A review of Resident A's care plan, dated June 26, 2023, indicated, .Resident is at risk for pain r/t (related to) risk factors .Interventions .Administer medications as ordered . A review of Resident A's Order Summary Report, included the following physician's order: - Monitor level of pain (0-10 scale): Document pain level as follows: 0 = none, 1-3 = mild pain, 4-6 = moderate pain, 7-10 = severe pain, every shift, date order May 24, 2023; - Tramadol (a drug used for pain) tablet 50 mg every 6 (six) hours as needed for pain management Moderate pain (4-6 pain scale), date order February 27, 2024; and - Morphine Sulfate .100 MG/5ML .Give 0.50 ml by mouth every 4 (four) hours as needed for Severe pain (7-10), date order July 31, 2024, discontinued December 6, 2024; - Morphine Sulfate (a drug used to treat pain) 100 mg (milligram - a unit of measure)/5 ml (milliliter-a unit of measure), give 1 (one) ml as needed for wound treatment, may medicate prior to wound treatment, date order December 19, 2024; A review of Resident A's Medication Administration Record (MAR), for Morphine Sulfate 0.50 ml every 4 hours as needed for severe pain, for December 1 to 6, 2024, indicated morphine sulfate was administered to Resident A on December 4, 2024, at 12:20 a.m., with a pain scale of 5 (moderate pain). (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 01/21/2025 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)