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Complaint Investigation

Haven Post Acute

March 30, 2026 · San Bernardino, CA · 1311 E Date St
Citations 1
CMS Rating 4/5
Beds 99
Provider ID 056053
Healthcare Facility
Haven Post Acute
San Bernardino, CA  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
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

Haven Post Acute in San Bernardino, CA — inspection on March 30, 2026.

Found 1 citation. 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

FF0842
Resident Assessment and Care Planning Deficiencies

During a review of Resident 1 ' s Minimum Data Set (facility assessment tool), dated March 3, 2026, under Section C, it indicated her Brief Interview for Mental Status (BIMS- screening tool to assess resident's cognition) score was 12. (A BIMS score of 8-12 suggests moderate problems with thinking and memory).

During a concurrent interview and record review on March 17, 2026, at 3:34 PM, with two License Vocational Nurses (LVNs 1 and 2), LVNs 1 and 2 reviewed Resident 1's clinical records and could not find documentation indicating that Resident 1 reported fall within the facility.

During a telephone interview on March 18, 2026, at 2:28 PM, with RN 1, RN 1 stated that on March 3, 2026, she went to Resident 1's room after hearing a scream, and found Resident 1 in bed, who claimed to have fallen.

She stated that Resident 1 appeared disoriented and was unable to provide an answer when asked further about her alleged fall.

She stated that she conducted a thorough assessment of the resident's body and found no indications of injury.

During telephone interview on March 18, 2026, at 3:44 PM, with the Director of Nursing (DON), the DON stated she was unable to locate RN 1's documentation regarding Resident 1's reported fall.

She further stated RN 1 should have documented the incident despite Resident 1's history of Alzheimer disease.

She further stated that according to the policy a change of conditions must be documented.

During telephone interview on March 19, 2026, at 8:14 AM, with RN 1, RN 1 stated, she failed to document Resident 1's reported fall and her assessment, admitting it was her oversight. RN 1 acknowledged that the policy mandates documentation of all incidents. A review of the facility Policy and Procedures (P&P), titled, Charting and Documentation, dated 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.

The medical record should facilitate communication between the interdisciplinary team regarding the resident's condition and response to care.2.

The following information is to be documented in the resident medical record: .c.

Treatments or services performed; d.

Changes in the resident's condition; e.

Events, incidents or accidents involving the resident.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

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 Haven Post Acute or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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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.