Glendora Canyon Transitional Care Unit

F 0600 Level of Harm - Actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

(imaging study that takes pictures of bones and soft tissues) results, dated 8/23/2025, timed at 2:28 pm,

the X-ray indicated an acute comminuted fracture of the right 5th metacarpal beginning in the distal diaphysis (the main or midsection (shaft) of a long bone) and extending to the distal epiphysis with suspected intra-articular extension [(the rounded end of the bone). The breaking of the long bone leading to

the little finger in multiple pieces with a high likelihood of damage to the joint surface]. During a review of Resident 1's AR, the AR indicated Resident 1 was admitted to the facility 6/8/2025 with diagnoses that included type 2 diabetes (a disease that results in elevated levels of glucose in the blood) and essential hypertension (high pressure of blood pushing against the wall of the arteries). During a review of Resident 1's History and Physical (H&P) Examination, dated 6/9/2025, the H&P indicated Resident 1 had the capacity to understand and make decisions. During a review of Resident 1's SBAR Communication Form, dated 8/23/2025, the form indicated Resident 1 had a disagreement with [Resident 2] and Resident 1 pushed Resident 2. During an interview on 8/28/2025 at 11 am with Resident 1, Resident 1 stated on 8/23/2025 (could not remember the time) Resident 1 had an altercation (a conflict that can range from verbal arguments to physical fights, occurring between two or more individuals receiving care) with Resident 2. Resident 1 stated Resident 2 was sitting across the hall and Resident 1 was walking into Resident 1's room when Resident 2 said something to Resident 1 and Resident 1 told Resident 2 to, shut up and mind his [Resident 2's] own business. Resident 1 stated Resident 2 was walking toward Resident 1 and, I pushed and dropped Resident 2 to the ground, and he [Resident 2] started yelling he [Resident 1] hit me. During an interview on 9/2/2025 at 1 pm with Licensed Vocational Nurse (LVN) 3, LVN 3 stated on 8/23/2025 at 11:30 am LVN 4 yelled out, Resident 2 is on the floor. LVN 3 stated, LVN 3 ran toward LVN 4 and when LVN 3 arrived Resident 2 was on the floor on Resident 2's left side, and Resident 1 was standing over Resident 2. LVN 3 stated Resident 1 told Resident 2, That is what you get they should have kicked you out a long time ago. LVN 3 stated Resident 2 did not respond to Resident 1, turned to LVN 3 and stated, My back and arm are hurting [pain unrated], call an ambulance because I do not feel I can get up from the floor. LVN 3 stated Resident 2 complained of 7 out of 10 pain on Resident 2's back and [right] arm. During

an interview on 9/2/2025 at 2:33 pm with LVN 4, LVN 4 stated LVN 4 heard a staff (unidentified) say Mister fell. LVN 4 stated LVN 4 rushed down the hallway and observed Resident 1 standing by Resident 1's room yelling and laughing at Resident 2 and stated, That is what you get you should not be here, yea I pushed him so what, I pushed him. Resident 2 was lying on the floor and stated, Help me, I can't get up. During a

review of the facility's P&P titled, Abuse, Neglect, Exploitation, and Misappropriation Prevention Program, dated April 2021, the P&P indicated, residents have the right to be free from abuse, neglect, misappropriation of resident property, and exploitation. The P&P indicated, this includes but is not limited to freedom from corporal punishment (the use of physical force to cause pain or discomfort as a way to discipline or correct a behavior), involuntary seclusion (keeping someone separated from others against their will), verbal, mental, sexual, or physical abuse. The P&P indicated, the resident abuse, neglect and exploitation prevention program consisted of a facility-wide commitment and resource allocation to support

the following objectives: 1. Protect residents from abuse, neglect, exploitation or misappropriation of property by anyone including, but not necessarily limited to: b. other residents.

Event ID:

Facility ID:

If continuation sheet

Printed: 04/13/2026 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

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

09/17/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Glendora Canyon Transitional Care Unit

401 W. Ada Ave.

Glendora, CA 91741

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)

Federal health inspectors cited GLENDORA CANYON TRANSITIONAL CARE UNIT in GLENDORA, CA for a deficiency under regulatory tag F-F0609 during a complaint investigation conducted on 2025-09-17.

Category: Freedom from Abuse, Neglect, and Exploitation Deficiencies

The facility was found deficient in the following area: Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.

While no actual harm was documented, there was potential for more than minimal harm to residents.

This was one of 2 deficiencies cited during this inspection of GLENDORA CANYON TRANSITIONAL CARE UNIT.

Correction Status: Deficient, Provider has date of correction.

The facility reported correction as of 2025-10-10.