Complaint Investigation

Inland Valley Care And Rehabilitation Center

May 9, 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 →

Source Document

Official CMS Inspection Report (Medicare.gov) · 16 pages

Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.

Inspection Summary

INLAND VALLEY CARE AND REHABILITATION CENTER in POMONA, CA — inspection on May 9, 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

FF641

Minimal harm or eyes closed. The SBAR indicated at 11:10 pm, Resident 1 was heard, by LVN 4, calling out for O2. The Some between 12:15 am and 12:30 am, Resident 1 complained of 8 out of 10 pain (severe pain) to the abdomen. affected

During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool), dated 4/7/2025, the MDS indicated Resident 1 had intact cognition (ability to think, remember, and reason).

The MDS indicated Resident 1 required substantial/maximal assistance (helper does more than half the effort) with toileting hygiene.

During a review of Resident 1's Medication Administration Record (MAR, a log initialed and/or signed by the licensed nurse with the date and time a medication was administered to a resident) dated 5/5/2025 to 5/7/2025, the MAR did not indicate Resident 1 had pain.

During a review of Resident 1's Progress Notes (PN), dated 5/6/2025, timed at 7:51 am, the PN indicated at 6:05 am, Resident 1 complained of not having a BM for two days.

The PN indicated Resident 1 complained of abdominal pain (unrated), bloating, and feeling uncomfortable during the night shift (11 pm to 7 am).

The PN indicated Resident 1 was on two LPM of O2 via NC.

During a review of Resident 1's eINTERACT SBAR form dated 5/6/2025, timed at 8 am, the SBAR indicated RN 3 documented Resident 1 had a COC due to constipation.

The SBAR form did not indicate Resident 1 had abdominal distention, firmness, bloating, or pain.

During a review of Resident 1's PN dated 5/6/2025 between 3 pm and 11 pm, the PN did not indicate an abdominal/GI evaluation (assessment) was completed.

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 05/09/2025

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

Inland Valley Care and Rehabilitation Center 250 W.

Artesia Street Pomona, CA 91768

FF842

Immediate the large intestine, a long, continuous tube that connects to the colon [the longest part of the large intestine] Few affected

During a review of Resident 1's care plan (CP) titled, COPD, initiated on [DATE] and reevaluated on , d+[DATE], the CP indicated Resident 1 was at risk for discomfort, shortness of breath, and exacerbation (worsening) secondary (due to) COPD.

The CP interventions indicated Resident 1 to receive O2 at two liters (unit of volume) per minute (LPM) via nasal canula (NC- tube which on one end splits into two prongs which are placed in the nostrils to deliver oxygen).

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 05/09/2025

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.

More Reports

About This Inspection Report

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.