Mirage Post Acute

During a review of Resident 1 ' s Minimum Data Set (MDS - a resident assessment tool), dated 3/12/2025, the MDS indicated Resident 1 was severely impaired with thought process and required substantial assistance from staff to complete activities of daily living (ADLs - activities such as bathing, dressing, and toileting a person performs daily).

During a review of Resident 1 ' s record titled, eInteract Change of Condition Evaluation, dated 3/12/2025 at 11:40 p.m., the evaluation indicated Resident 1 had a change of condition of Abnormal vital signs and altered mental status (a change in a resident ' s mental state, including changes in awareness, alertness, and mental function).

The evaluation indicated on 3/12/2025 at 5 p.m., Resident 1 ' s BP on a sitting position taken on Resident 1 ' s right arm was 86/57 mmHg and HR of 111 bpm.

The evaluation indicated there were no other BP and HR assessments collected for Resident 1 after 5 p.m. on 3/12/2025.

During a review of the physician ' s Progress Notes (PN) for Resident 1, dated 3/13/2025 at 1:06 a.m., the PN indicated Resident 1 ' s Medical Doctor (MD) 1 called RN 1 after multiple times before RN 1 answered.

The PN indicated MD 1 instructed RN 1 to check and examine Resident 1, then call back MD 1.

The PN indicated RN 1 called back and told MD 1, Resident 1 ' s BP was 86/57 mmHg and HR was 111 bpm (these vital signs were the same readings taken on 3/12/2025 at approximately 5 p.m.).

The PN indicated RN 1 told MD 1 that it was unclear if Resident 1 was responsive (able to respond or reply) or not, so MD 1 ordered Resident 1 to be transferred to a GACH.

056039

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 056039 B.

Wing 03/28/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Mirage Post Acute 44445 15th St W Lancaster, CA 93534