Health inspection·April 29, 2025

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure monitoring for one of three sampled residents (Resident 1), of the following: 1. Behavior of anxiety (feeling of fear, dread, and uneasiness); 2. Psychotic behavior (refers to the observable actions, thoughts, and expression of a person experiencing psychosis [mental state or condition itself, describing a range of symptoms including those that manifest as psychotic behavior]); and 3. Side effects for use of psychotropic medications (drugs that affect the brain and nervous system, primarily used to treat mental health conditions). This failure had the potential for unnecessary medication use. Findings: On April 4, 2025, at 9:10 a.m., an unannounced visit was conducted at the facility. A review of Resident 1's admission Record, indicated Resident 1 was admitted to the facility on [DATE], under general in-patient hospice (a short-term, crisis-like level of care for hospice patients who need more intensive symptom management) care with diagnoses which included dementia (a loss of thinking, remembering, and reasoning skills), Parkinson's disease (a movement disorder of the nervous system that worsens over time) and uncontrolled behaviors, danger to self and others. A review of Resident 1's History and Physical Examination, dated March 19, 2025, indicated Resident 1 does not have the capacity to understand and make decisions. A review of Resident 1's Order Summary Report, dated April 4, 2025, indicated the following medications were ordered on March 19, 2025: a.Lorazepam Oral Concentrate 2 MG/ML (Lorazepam- psychotropic medication) Give 1 ml by mouth every 4 hours for Anxiety, restlessness, agitation, SOB (shortness of breath) .; b.Quetiapine Fumarate Oral Tablet 50 MG (Quetiapine Fumarate- psychotropic medication) Give 1 tablet by mouth in the morning for Psychosis M/B Unprovoked Physical Behavior for 15 Days .; (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: 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 04/29/2025 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)