Community Hospital Of San Bernardino Dp Snf
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
ventilator or its setting. At approximately 1:45 PM, RT1 came and told her that Resident 1 was unresponsive, so RN 1 immediately went to Resident 1's room and code blue was initiated. During an
interview on [DATE REDACTED], at 1:45 PM, with Certified Nursing Assistant (CNA 1), CNA 1 stated that she took Resident 1 to shower room with CNA 2 and RT 1 on [DATE REDACTED], at 10:30 AM. CNA 1 saw RT 1 disconnected Resident 1 from ventilator and attached it to Ambu bag (a device used to provide positive pressure ventilation to patients who are not breathing or have difficulty breathing). Upon returning from the shower RT 1 disconnected Ambu bag and reconnected Resident 1 back to the ventilator. CNA 1 further stated she did not see the ventilator being turned on. During an interview on [DATE REDACTED], at 2:00 PM, with RT 1, RT 1 stated that on [DATE REDACTED], he assisted with Resident 1's shower. RT 1 reported shower took approximately 30 minutes, from 10:30 AM to 11:00 AM. RT 1 stated, he disconnected Resident 1 from the vent and connected to Ambu bag to 10 liters per minute (L/min) of oxygen cylinder for transfer to shower gurney (hospital stretcher or transport bed). Upon returning from the shower, RT 1 stated he reconnected Resident 1 to the ventilator, resumed ventilation from standby mode, and performed dressing change on tracheostomy. RT 1 further stated during routine rounds at 1:35 PM, RT 1 found Resident 1 was lying in bed, pale, eyes closed, unresponsive, no pulse or respirations, and the ventilator was on standby mode. RT 1 notified charge nurse and code blue started immediately. During an interview on [DATE REDACTED], at 2:25 PM, with CNA 2, CNA 2 stated that she was working with CNA 1 on [DATE REDACTED], and helped with showering Resident 1. which took 30 minutes to complete the task. CNA 2 further stated RT1 connected Resident 1 back to the ventilator and changed tracheostomy dressing, but CNA 2 does not remember looking at the ventilator.
During a concurrent interview and record review on [DATE REDACTED], at 2:25 PM, with Bio Med Technician (BMT),
the facility's document titled, [Brand name] Ventilator [Serial number], Export timestamp: 2025-11-19_09-57-00, dated from [DATE REDACTED], at 8:04 AM through [DATE REDACTED], 1:55 PM, was reviewed. The document indicated that the ventilator was on standby mode. BMT verified and confirmed that the ventilator was on Standby mode from 10:35 AM to 1:39 PM (3 hours and 4 minutes). A follow-up concurrent interview and record review on [DATE REDACTED], at 2:35 PM, with BMT, the facility's document titled, OEM [Original Equipment Manufacturer] -Scheduled Preventative Maintenance, dated [DATE REDACTED], was reviewed. The document indicated that the scheduled preventative maintenance for [Brand name] Ventilator [Serial number], was conducted
on [DATE REDACTED]. BMT stated that there was nothing wrong with the ventilator. A review of Resident 1's Nursing Progress Note, dated [DATE REDACTED], indicated, Resident 1 was transferred after the emergency response to ICU
on [DATE REDACTED], at 2:18 PM, for close observation and treatment. During an observation of Resident 1 in ICU, on [DATE REDACTED], at 2:45 PM, Resident 1 was observed lying in bed attached to ventilator, with FiO2 (the percentage of oxygen a person inhales with each breath with the maximum of 100 percent) set at 30 percent. During a concurrent interview and record review on [DATE REDACTED], at 3:10 PM, with the DCPS, the facility's document titled, [Brand name] Ventilator [Serial number], Export timestamp: 2025-11-19_09-57-00, dated from [DATE REDACTED], at 8:04 AM, through [DATE REDACTED], at 1:55 PM, was reviewed. The document indicated that the ventilator was on standby mode. The DCPS verified and confirmed RT 1 did not resume ventilation from standby mode. As a result, Resident 1 experienced respiratory arrest (a person has stopped breathing or is breathing so weakly that is not sustainable for life), which led to initiation of code blue and transferred to ICU for closed
observation and treatment.
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COMMUNITY HOSPITAL OF SAN BERNARDINO DP SNF in SAN BERNARDINO, 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 SAN BERNARDINO, 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 COMMUNITY HOSPITAL OF SAN BERNARDINO DP SNF or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.