Skip to main content
Complaint Investigation

Bethany Home Society San Joaquin County

September 8, 2025 · Ripon, CA · 930 West Main Street
Citations 2
CMS Rating 4/5
Beds 92
Provider ID 055662
Healthcare Facility
Bethany Home Society San Joaquin County
Ripon, CA  ·  View full profile →
Inspection Summary

BETHANY HOME SOCIETY SAN JOAQUIN COUNTY in RIPON, CA — inspection on September 8, 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.

Advertisement

Inspection Findings

FF0658
Resident Assessment and Care Planning Deficiencies
Potential for More Than Minimal Harm

During a review of Resident 1's blood pressure and heart rate entries, the DON acknowledged that Resident 1's did have high and low blood pressures and low heart rates that would have indicated a need to hold the Metoprolol, complete orthostatic blood pressures, and to notify the physician, especially if there was a history of syncope during transfers.

The DON stated that the lack of further assessment into Resident 1's blood pressure and heart rate fluctuations by the nursing staff placed Resident 1 at risk for continued syncopal episodes which could result in a fall and further injury.During a review of the facility's policy and procedure (P&P) titled, Receiving Physician Medication Orders, dated 11/1/15, the P&P indicated, .Purpose: Clarification of Physician's orders - receiving orders for the medication for abnormal vital signs.B/P: Any abnormal B/P systolic > [greater than] 170 or < [less than] 100 diastolic [bottom number of BP reading] >90 or <40, physician notification is required.If an order is received, b/p parameters are to be included (i.e., Medication given for sbp [systolic blood pressure, top number of BP reading] >170 or hold medication for sbp <100).Pulse: Any abnormal pulse >100 or <60, physician notification is required.If an order is received for any medication, it must include the parameters.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

09/08/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Bethany Home Society San Joaquin County

930 West Main Street Ripon, CA 95366

SUMMARY STATEMENT OF DEFICIENCIES

that Resident 1 had not been screened by physical therapy when Resident 1 was readmitted from the acute hospital on 7/2/25 with new diagnoses of right shoulder dislocation and right humorous fracture.

The DOR further stated that the physical therapist should have screened Resident 1's mobility, reassessed Resident 1's ordered RNP, and provided education to the CNAs and RNAs to ensure they were able to properly place the right arm immobilizer.During a concurrent interview and record review on 9/5/25 at 3:53 PM, Resident 1's physician order for the immobilizer to the right arm, dated 7/7/25, and Resident 1's RNP order for PROM to the upper and lower extremities three times weekly as tolerated, dated 2/25/20, were reviewed with the Director of Nurses (DON).

The DON stated that since the immobilizer was on Resident 1's right arm, the expectation was that the RNAs would know not to perform the PROM exercises or to remove the immobilizer even though Resident 1's RNP order had not been updated upon Resident 1's return from the acute hospital on 7/2/25.

The DON further stated that updating the RNP order to exclude PROM to the right upper arm, as well as providing training to the RNA and CNA on removing and placing the immobilizer, techniques in positioning Resident 1's right upper arm during care tasks such as bathing, dressing, bed mobility and transferring to and from her bed and wheelchair should have been done to help reduce the risk of further injury to Resident 1's right upper arm and shoulder.A review of the facility's job description titled, JOB DESCRIPTION RESTORATIVE NURSING ASSISTANT, dated 8/15, the record indicated, .documents on e-chart [electronic medical record] all activities performed in restorative program and the progress and changes that are observed.A review of the facility's policy and procedure (P&P) titled, RANGE OF MOTION, dated 11/15, the P&P indicated .All residents admitted to [facility name] LTC [long term care] will be screened for current mobility status within 7 days from admission.Residents identified as having a decline in ROM [range of motion] will be referred to PT/TO [physical therapy/occupational therapy] for screening and recommendations.

Facility ID:

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 RIPON, 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 BETHANY HOME SOCIETY SAN JOAQUIN COUNTY or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


More Reports

Advertisement