Other·January 25, 2019

F000 INITIAL COMMENTS

F000 PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE The following reflects the findings of the California Department of Public Health during an abbreviated standard survey. Complaint Number: 606569 Representing to Department: 34510, HFEN 40768, HFEN The inspection was limited to the specific complaint investigated and does not represent the findings of a full inspection of the facility. Two deficiencies were written as a result of complaint 606569.

F656 SS=D Develop/Implement Comprehensive Care Plan F656 CFR(s): 483.21(b)(1) 01/07/2019 §483.21(b) Comprehensive Care Plans §483.21(b)(1) The facility must develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights set forth at §483.10(c)(2) and §483.10(c)(3), that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. The comprehensive care plan must describe the following (i) The services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being as required under §483.24, §483.25 or §483.40; and (ii) Any services that would otherwise be required under §483.24, §483.25 or §483.40 LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE 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. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: CI4K11 Facility ID: CA630013665 If continuation sheet 1 of 9 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555877 (X3) DATE SURVEY COMPLETED 12/26/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE RIDGECREST REGIONAL TRANSITIONAL CARE AND REHABILITATION UNIT 1081 N China Lake Blvd Ridgecrest, CA 93555 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE but are not provided due to the resident's exercise of rights under §483.10, including the right to refuse treatment under §483.10(c)(6). (iii) Any specialized services or specialized rehabilitative services the nursing facility will provide as a result of PASARR recommendations. If a facility disagrees with the findings of the PASARR, it must indicate its rationale in the resident's medical record. (iv)In consultation with the resident and the resident's representative(s)(A) The resident's goals for admission and desired outcomes. (B) The resident's preference and potential for future discharge. Facilities must document whether the resident's desire to return to the community was assessed and any referrals to local contact agencies and/or other appropriate entities, for this purpose. (C) Discharge plans in the comprehensive care plan, as appropriate, in accordance with the requirements set forth in paragraph (c) of this section. This REQUIREMENT is not met as evidenced by: Based on interview and record review, the facility failed to develop and implement a care plan for one of four sampled residents (Resident 1) for the issues of: 1. Resident 1's wound care of her left hand caused by her contracted (inability to relax and straighten her hand) left hand; and, 2. Resident 1's surgical repair of the left hand contracture. This had the potential for unmet care needs for Resident 1. Findings: FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: CI4K11 Facility ID: CA630013665 If continuation sheet 2 of 9 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555877 (X3) DATE SURVEY COMPLETED 12/26/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE RIDGECREST REGIONAL TRANSITIONAL CARE AND REHABILITATION UNIT 1081 N China Lake Blvd Ridgecrest, CA 93555 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE During a review of the clinical record for Resident 1, the Surgical Report, dated 4/9/18 indicated this 80-year-old female entered the hospital on this date for surgery to repair her "left hand contracture." The report also indicated there was "Left hand poor hygiene because of the contracture, left palm pressure wound due to pressure of the nails. The patient has got a significance [sic] hand contracture with the nails digging into the left palm." The Surgical Report indicated the surgeon then repaired the wound to her palm. During an interview with the Licensed Vocational Nurse (LVN), on 10/9/18, at 10:12 AM, she stated "I did wound care on her hand after surgery." When asked for a care plan for the wound care, LVN stated "I couldn't find one." During an interview with Registered Nurse 2, on 10/12/18, at 10 AM, she stated "No, I did not start" a wound care plan for Resident 1's left hand wound. During a review of the clinical record for Resident 1, no evidence of wound care and post-operative wound care, care plans were noted.

F686 Treatment/Svcs to Prevent/Heal Pressure Ulcer F686 01/07/2019 SS=G CFR(s): 483.25(b)(1)(i)(ii) §483.25(b) Skin Integrity §483.25(b)(1) Pressure ulcers. Based on the comprehensive assessment of a resident, the facility must ensure that(i) A resident receives care, consistent with professional standards of practice, to prevent pressure ulcers and does not develop pressure ulcers unless the individual's clinical condition demonstrates that they were unavoidable; and FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: CI4K11 Facility ID: CA630013665 If continuation sheet 3 of 9 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555877 (X3) DATE SURVEY COMPLETED 12/26/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE RIDGECREST REGIONAL TRANSITIONAL CARE AND REHABILITATION UNIT 1081 N China Lake Blvd Ridgecrest, CA 93555 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE (ii) A resident with pressure ulcers receives necessary treatment and services, consistent with professional standards of practice, to promote healing, prevent infection and prevent new ulcers from developing. This REQUIREMENT is not met as evidenced by: Based on interview and record review, the facility failed to ensure one of four sampled residents (Resident 1) received adequate care and services necessary to prevent a pressure injury/ulcer to her left hand. This injury developed when her contracted fingers pressed her untrimmed fingernails into the palm of her left hand, causing a 2.5 centimeter (cm) pressure injury. This required surgery to multiple areas to her left arm to release the contractures and to repair the pressure injury, creating surgical risks (potential complications include nerve damage and pain). Note: "Contracture" is when the normally stretchy or elastic tissues are replaced by nonstretchy fiber-like tissue. This makes it hard to stretch the area and prevents normal movement. Contractures mostly occur in the skin, the tissues underneath, and the muscles, tendons, ligaments surrounding a joint. They affect range of motion and function in a certain body part. Often, there is also pain. Findings: During a review of the clinical record, the Record of Admission indicated Resident 1 was admitted to the facility on 11/5/13, was a, 80years-old female, and had diagnoses that included Alzheimer's Disease, which significantly affects memory, judgement, and mood. The Surgical Report, dated 4/9/18 indicated FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: CI4K11 Facility ID: CA630013665 If continuation sheet 4 of 9 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555877 (X3) DATE SURVEY COMPLETED 12/26/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE RIDGECREST REGIONAL TRANSITIONAL CARE AND REHABILITATION UNIT 1081 N China Lake Blvd Ridgecrest, CA 93555 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE Resident 1 entered the hospital on this date for surgery to repair her "left hand contracture." The report also indicated there was "Left hand poor hygiene because of the contracture, left palm pressure wound due to pressure of the nails. The patient has got a significance [sic] hand contracture with the nails digging into the left palm. The patient is in quite a bit of pain and does not let anybody touch the hand or the [sic] let us examine it. At this stage, the patient has extremely poor hygiene of the left hand." The Surgical Report also indicated Resident 1 was then placed under general anesthesia, which is a state of deep unconsciousness induced by medications, which carries risk of changes in blood pressure, irregular heartbeats, heart attack, allergic reactions, cardiac arrest, airway blockage, lack of oxygen, physical injury such as chipped teeth, loss of teeth, muscle cramps, and death. Risks are more common in the elderly. The Surgical Report indicated the procedure consisted of making cuts into the skin to cut her arm and finger tendons. The Surgical Report indicated the surgeon then repaired the wound to her palm. The report indicated "At this stage, there was a significant amount of maceration (softening of tissues) on the skin of the palm and in between the fingers. At this stage, with the help of a Betadine scrubber, thorough cleaning of the hand and nails was carried out. All the nails of the left hand were really elongated and really dirty, and had not been cleaned for months. At this stage, there was approximately about a 2.5 cm wound in the palm from the digging of middle finger nail [the surgeon then surgically cut another tendon in the area]. Thorough irrigation and debridement [the removal of damaged tissue or foreign objects] of the wound was carried out at this stage." FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: CI4K11 Facility ID: CA630013665 If continuation sheet 5 of 9 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555877 (X3) DATE SURVEY COMPLETED 12/26/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE RIDGECREST REGIONAL TRANSITIONAL CARE AND REHABILITATION UNIT 1081 N China Lake Blvd Ridgecrest, CA 93555 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE The Minimum Data Set (a standardized comprehensive assessment) dated 2/11/18, indicated Resident 1 never rejected care that was necessary to achieve the resident's goals for health and well-being. The Nursing Home Progress Note, dated 3/5/18, written by Resident 1's physician, indicated "Physical Exam," and "she is currently stable," and makes no mention of her left hand contracture. During a concurrent review of Resident 1's clinical record and interview with Licensed Vocational Nurse 1 (LVN 1), on 10/9/18, at 10:12 AM, she stated for any residents with hand contractures, she would clean and clip their fingernails. LVN 1 stated to ensure this care was delivered, "We inform the CNAs [Certified Nursing Assistants] to continue care, we have RNAs [Restorative Nursing Assistants] who helps with ADLs [Activities of Daily Living]." LVN 1 could not find a care plan for any wound care for Resident 1's left hand wound. During an interview with LVN 2, on 10/9/18, at 12:15 PM, she stated if a resident has a hand contracture, "I would ask the doctor to order nail clipping if we were unable to." During an interview with the RNA, on 10/11/18, at 10 AM, she described Resident 1's left hand as a "fist closed with long nails." The RNA stated she reported these findings to the nurse on duty. The RNA stated, "When her daughter was here, she would too inform the [unknown] nurse." During an interview with Registered Nurse 2 (RN 2), on 10/12/18, at 10 AM, she stated Resident 1's left hand was "very contracted and FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: CI4K11 Facility ID: CA630013665 If continuation sheet 6 of 9 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555877 (X3) DATE SURVEY COMPLETED 12/26/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE RIDGECREST REGIONAL TRANSITIONAL CARE AND REHABILITATION UNIT 1081 N China Lake Blvd Ridgecrest, CA 93555 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE her nails were long." RN 2 did not recall Resident 1's nails ever getting filed or cut. RN 2 stated she "noticed a wound to Resident 1's left palm. There was a smell, too." RN 2 stated she "did not start" a wound care plan for Resident 1. During an interview with Resident 1's daughter, on 11/6/18, at 2:20 PM, she stated, "I have been to every care conference [at the facility] for a year prior to my mom having surgery. I had to force them to call a specialist to see her hand. For one year, my mother's hand was clenched. Every time I would ask the staff [to provide care for her hand] they would say 'someone is going to do it,' or they were going to send her to the foot doctor. She would come back [to the facility] with her toenails clipped, but not her fingernails." During a review of the clinical record for Resident 1, there was no documentation found to indicate nail trimming was ever performed. The Screening Referral to Rehabilitation Services, dated 8/28/17, indicated Resident 1 was identified as "high risk for worsening contractures." The RNA Referral Form, dated 8/29/17 indicated a RNA was ordered to perform gentle range of motion exercise to left hand [contracture] as tolerated. . . to prevent further contracture." The Interdisciplinary Progress Notes dated 11/21/17, at 4:03 PM, indicated Resident 1 "had a left hand contracture. . . Discussed hygiene and pressure injury risks. Pressure injury risks discussed." The Notes dated 2/27/18, at 12 PM, indicated Resident 1 "has no skin issues. Her hands are swollen and contractured." FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: CI4K11 Facility ID: CA630013665 If continuation sheet 7 of 9 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555877 (X3) DATE SURVEY COMPLETED 12/26/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE RIDGECREST REGIONAL TRANSITIONAL CARE AND REHABILITATION UNIT 1081 N China Lake Blvd Ridgecrest, CA 93555 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE The Interdisciplinary Progress Notes dated 3/15/18, indicated Resident 1 "had a manicure and polished her nails." The Interdisciplinary Progress Notes dated 3/22/18, at 5:33 PM, indicated that Resident 1 had a "Odorous, foul smell coming from left hand, after shower, when attempt made to evaluate Left contracture hand, resident begins swinging her right hand to hit, at the nurse examining hand. Resident complains of pain to Left hand. Nail beds of fingers, number 3, 4, 5, noted to be imbedded of Left hand. [Resident 1's physician] notified, and stated to send to ER [Emergency Room] for Evaluation and treatment." The Notes dated 3/22/18, at 8:36 PM, indicated the ER physician "states that this is not an emergency and should be sent back. Staff is aware that this is not a change in condition for the resident [a strong muscle relaxer and sedative were ordered to be given routinely to the resident]." The Notes dated 3/22/18, at 10:31 PM, indicated "Resident has a strong foul odor coming from hand, suspected infection." The Notes dated 3/27/18, at 4:29 PM, indicated Resident 1's physician was "notified of fall and continued problem with nail beds of left hand digits 3, 4, 5, imbedding into skin of left palm related to contracture. New orders noted [orders were for medications, not treatment to the hand, nails, or dressings to wound]." The Post Fall Assessment, dated 3/27/18, indicated Resident 1 was started on antibiotics on that date, five (5) days after a foul odor was noted from the area, and her ER visit, for "Right [sic] hand infection related to contracture of hand." The Notes dated 3/30/18, at 12:41 PM, from FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: CI4K11 Facility ID: CA630013665 If continuation sheet 8 of 9 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555877 (X3) DATE SURVEY COMPLETED 12/26/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE RIDGECREST REGIONAL TRANSITIONAL CARE AND REHABILITATION UNIT 1081 N China Lake Blvd Ridgecrest, CA 93555 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE the Wound Care Registered Nurse, indicated no new treatment was ordered to the area, "unable to provide dressing treatment due to fused fingers." An appointment was made for a surgeon to evaluate on 4/4/18. The Medication Administration Record (MAR) for March and April 2018 indicated Resident 1 was medicated for pain on 3/28/18, 4/3/18, 4/7/18, 4/10/18 twice, 4/12/18, 4/13/18 twice, 4/15/18, 4/16/18, 4/17/18, and 4/19/18. The facility policy and procedure titled "Transitional care and rehab unit Care of Fingernails/Toenails Level II," dated 11/30/16, indicated "Nail care includes daily cleaning if needed and regular trimming. Nail care is always provided during showers. Stop and report to the nurse supervisor if there is evidence of ingrown nails, infection, pain, or if nails are too hard or too thick to cut with ease. If the resident refused the treatment, the reason(s) why and the intervention taken should be recorded in the resident's medical record." FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: CI4K11 Facility ID: CA630013665 If continuation sheet 9 of 9