Country Oaks Care Center
COUNTRY OAKS CARE CENTER in POMONA, CA — inspection on March 6, 2025.
Found 2 citations. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
During a review of the Maintenance Department's logs titled, Wall Penetration, dated January 2024 to December 2024, the logs did not indicate any repairs were made to Bathroom [ROOM NUMBER] nor were Bathroom [ROOM NUMBER] listed on the logs as needing repairs.
055247
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 055247 B.
Wing 03/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Country Oaks Care Center 215 W Pearl St Pomona, CA 91768
During a review of Resident 20's Minimum Data Set (MDS, resident assessment tool), dated 1/10/2025, the MDS indicated Resident 20 had severe impaired cognition for daily decision making.
The MDS indicated, Resident 20 was dependent on staff for oral hygiene, toileting hygiene, showering, upper and lower body dressing, putting on/taking off footwear, and personal hygiene.
During a review of Resident 20's Order Summary Report (OSR), dated active as of 3/4/2025, the OSR included a physician's order, dated 1/23/2025, the order indicated, to administer Isosource 1.5 (nutritional formula) rate at 63 cubic centimeter (cc, unit of measurement) per hour (cc/hr) for 20 hours.
The order indicated a start time of 12 noon and an off time of 8 AM or until 1260 cc was infused.
During an observation on 3/3/2025 at 9:18 AM, Resident 20 was awake, lying in bed, and CNA 1 was at Resident 20's bedside. Resident 20's GT tubing was hanging on a pole and was disconnected from Resident 20.
During an interview on 3/3/2025 at 9:25 AM, with CNA 1, CNA 1 stated, I disconnected the GT feeding from the resident [Resident 20] and hung the tubing on the GT machine. I turned [the machine] off and on.
During an interview on 3/3/2025 at 9:26 AM, Licensed Vocational Nurse 1 (LVN 1) stated, the GT feedings should not be disconnected from the residents [by CNAs]. LVN 2 stated, CNAs should not turn on or off the GT machine because they were not licensed to do it.
055247
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 055247 B.
Wing 03/06/2025
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Country Oaks Care Center 215 W Pearl St Pomona, CA 91768
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.