Arlington Gardens Care Center
Inspection Findings
F-Tag F0627
F 0627 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
the restroom, somebody should be with her going to the restroom because she could fall. The DON stated
the expectation was for the receiving facility to have the knowledge, training, and skills needed to care for
the resident.On October 15, 2025, at 1:40 p.m., during a telephone interview with the ADM, he stated the placement agencies were used as a resource to assist with resident placement, and his expectation was for
the facility staff to verify that receiving facility can meet the resident's needs to ensure a safe and appropriate discharge.Seven days after the resident was discharged from the skilled nursing facility to the room and board, Resident 1's family had her transferred via ambulance to the general acute care hospital (GACH) on October 7, 2025.A review of Resident 1's GACH record titled, Emergency Record, dated October 7, 2025, indicated, .from SNF (sic).Family AMA'd (against medical advice-leaving the facility against the advice of a medical professional) pt (patient) due to disappointment regarding care at the facility.A review of Resident 1's Urinalysis (a laboratory test that examines a sample of urine), and Bacteriology (a laboratory test that detects bacteria), dated October 7, 2025, indicated Resident 1 had a urine infection.A facility policy and procedure specific on managing safe discharge was requested but the facility did not have this policy and procedure.A review of the facility's policy and procedure titled, Transfer or Discharge Notice, revised March 2021, indicated, .In determining the transfer location for a resident, the decision to transfer to a particular location is determined by the needs, choices and best interests of the residents.
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Printed: 04/13/2026 Form Approved OMB No. 0938-0391
Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
10/20/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Arlington Gardens Care Center
3688 Nye Avenue Riverside, CA 92505
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)
F-Tag F0842
F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
language and format that understand at least thirty (30) days prior to transfer or discharge.Residents are permitted to stay in the facility and not be transferred or discharged unless.the transfer is necessary for the resident's welfare and the resident's needs cannot be met in the facility.Residents have the right to appeal.a transfer or discharge through the state agency that handles appeals.2. A review of Resident 1's SBAR (Situation, Background, Assessment, and Recommendation - a communication framework used to structure conversations about patient updates between team members) Communication Form, dated August 10, 2025, indicated Resident 1 had a witnessed fall and Resident 1's daughter was notified on August 10. 2025, at 12 a.m.On October 20, 2025, at 1:33 p.m., during a concurrent interview and record
review with the DON, she stated Resident 1 had a witnessed fall on August 10, 2025, with no injury. She stated a fall incident was considered a change in condition. She stated the resident's physician, and RP should be notified. The DON stated the documented time of 12 a.m., was probably incorrect. She stated the nurses were expected to document accurately. She also stated there was no other documentation regarding family notification.On October 20, 2025, at 3:51 p.m., during a telephone interview with the Licensed Vocational Nurse (LVN), she stated Resident 1 had witnessed fall. The LVN could not remember
the exact date and time the fall incident happened. She stated it was around the evening time. The LVN stated she called the RP and left a message. She stated she called the RP the second time and there was no answer. She stated she did not leave any message on her second call. She stated she initiated the first call immediately after she received an order from Resident 1's physician. The LVN stated she should have changed the time to reflect the actual time she called the RP. The LVN stated she could not recall if she documented any of her calls to Resident 1's RP in the progress notes.A review of the facility policy titled, Charting and Documentation, revised July 2017, indicated, .All services provided to the resident, progress toward the care plan goals, or any changes in the resident's medical, physical, functional, or psychosocial condition, shall be documented in the resident's medical record.Documentation in the medical record will be.complete, and accurate.
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ARLINGTON GARDENS CARE CENTER in RIVERSIDE, CA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
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 RIVERSIDE, 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 ARLINGTON GARDENS CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.