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Complaint Investigation

Inland Valley Care And Rehabilitation Center

February 25, 2025 · Pomona, CA · 250 W. Artesia Street
Citations 2
CMS Rating 1/5
Beds 221
Provider ID 056431
Healthcare Facility
Inland Valley Care And Rehabilitation Center
Pomona, CA  ·  View full profile →
Inspection Summary

INLAND VALLEY CARE AND REHABILITATION CENTER in POMONA, CA — inspection on February 25, 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.

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Inspection Findings

FF693
Minimal harm or Occupational Therapy (OT) Initial Evaluation (OT Eval), dated 11/15/2025 were reviewed. The OT Eval Few session of OT and did not receive four weeks of treatment from. The PT Eval indicated had a treatment plan affected

During a review of Resident 4's Minimum Data Set (MDS, a resident assessment tool), dated 12/20/2024, the MDS indicated Resident 4 was severely impaired (never/rarely made decisions) impaired in cognitive skills (ability to make daily decisions).

The MDS indicated Resident was dependent (helper does all the effort) on staff for toileting, oral, and personal hygiene, dressing, and bathing.

During a review of Resident 4's physician orders, the physician orders indicated the following therapy orders for Resident 4:

Occupational Therapy Evaluate and Treat as Indicated, dated 11/14/2024

Physical Therapy Evaluate and Treat as Indicated, dated 11/14/2024

OT eval completed awaiting authorization.

Once authorized OT clarification of order for skilled services QD (every day) 6 times a week for 4 weeks for tx (treatment) ., dated 11/15/2024

PT clarification order for Skilled Physical Therapy Services QD . X 4 wks (weeks) (awaiting auth from insurance .), dated 11/15/2024.

056431

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 056431 B.

Wing 02/25/2025

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

Inland Valley Care and Rehabilitation Center 250 W.

Artesia Street Pomona, CA 91768

During a review of Resident 4's Admission Record (AR), the AR indicated the facility admitted Resident 4 on 8/31/2024 diagnoses including traumatic subarachnoid hemorrhage (SAH, a type of bleeding in the brain), acute respiratory failure (when the lungs can't get enough oxygen into the blood), and dysphagia (difficulty swallowing foods or liquids).

During a review of Resident 4's Minimum Data Set (MDS, a resident assessment tool), dated 12/20/2024, the MDS indicated Resident 4 was severely impaired (never/rarely made decisions) impaired in cognitive skills (ability to make daily decisions).

The MDS indicated Resident was dependent (helper does all the effort) on staff for toileting, oral, and personal hygiene, dressing, and bathing.

During a concurrent observation and interview on 2/20/2025 at 2:15 p.m. with Licensed Vocational Nurse (LVN) 1in Resident 4's room, Resident 4 was lying in bed with Resident 4's enteral feeding (a method of providing nutrition directly into the gastrointestinal [GI] tract through a tube) running via Resident 4's G-tube.

The HOB was raised slightly. LVN 1 stated the HOB needed to be raised to 30 - 40 degrees. LVN 1 stated LVN 1 did not know how high the HOB was raised but was sure it was not raised high enough. LVN 1 stated there were no marks on the bedframe to determine the degree of the HOB.

During an interview on 2/24/2025 at 3:15 p.m. with the Director of Nursing (DON), the DON stated the HOB must be raised to 35-45 degrees whenever residents (in general) where receiving enteral feeding.

056431

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 056431 B.

Wing 02/25/2025

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

Inland Valley Care and Rehabilitation Center 250 W.

Artesia Street Pomona, CA 91768

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in POMONA, CA, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from INLAND VALLEY CARE AND REHABILITATION CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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