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Complaint Investigation

Bayshire San Dimas Post-acute

July 18, 2024 · San Dimas, CA · 1740 S San Dimas Ave
Citations 2
CMS Rating 4/5
Beds 45
Provider ID 555737
Healthcare Facility
Bayshire San Dimas Post-acute
San Dimas, CA  ·  View full profile →
Inspection Summary

BAYSHIRE SAN DIMAS POST-ACUTE in SAN DIMAS, CA — inspection on July 18, 2024.

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.

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Inspection Findings

FF660
Minimal harm or aimed to relieve pain, improve movement, and strengthen weakened muscles) and occupational therapy Few assistance with ADLs, hygiene, & grooming. The DS 2 indicated, under Medical Equipment Ordered, affected

During a review of Resident 2's History and Physical Examination (H&P 2), dated 5/20/2024, the H&P 2 indicated, Resident 2 was able to make needs known but could not make medical decisions.

During a review of Resident 2's Minimum Data Set (MDS 2- a standardized resident assessment and care-planning tool), dated 5/27/2024, the MDS 2 indicated, Resident 2 had absence of spoken words, had difficulty communicating some words or finishing thoughts but was able to if prompted or given time, and would miss part/intent of the message but would comprehend most of the conversation.

The MDS 2 indicated, Resident 2 had some difficulty making decisions regarding tasks of daily life in new situations only.

The MDS 2 indicated, Resident 2 was dependent on staff for toileting hygiene, bathing, lower body dressing, and putting on/taking off footwear.

The MDS 2 indicated, Resident 2 required substantial/maximal assistance with oral hygiene, upper body dressing, personal hygiene, and mobility.

555737

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 555737 B.

Wing 07/18/2024

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

Bayshire San Dimas Post-Acute 1740 S San Dimas Ave San Dimas, CA 91773

During a review of Resident 2's History and Physical Examination (H&P 2), dated 5/20/2024, the H&P 2 indicated, Resident 2 was able to make needs known but could not make medical decisions.

During a review of Resident 2's Minimum Data Set (MDS 2- a standardized resident assessment and care-planning tool), dated 5/27/2024, the MDS 2 indicated, Resident 2 had absence of spoken words, had difficulty communicating some words or finishing thoughts but was able to if prompted or given time, and would miss part/intent of the message but would comprehend most of the conversation.

The MDS 2 indicated, Resident 2 had some difficulty making decisions regarding tasks of daily life in new situations only.

The MDS 2 indicated, Resident 2 was dependent on staff for toileting hygiene, bathing, lower body dressing, and putting on/taking off footwear.

The MDS 2 indicated, Resident 2 required substantial/maximal assistance with oral hygiene, upper body dressing, personal hygiene, and mobility.

During a review of Resident 2's Physician Order (MDO 1), dated 7/9/2024, timed at 6:29 PM, the MDO 1 indicated, an order to discharge Resident 2 to home with Home Health (unspecified) on 7/9/2024.

The MDO 1 indicated, Resident 2 may have home health PT/OT & registered nurse (RN) for safety evaluation to follow.

The MDO 1 indicated, Resident discharged home with family at 5:40 PM.

During a telephone interview on 7/17/2024 at 2 PM with R2R, R2R stated Resident 2's discharge came as a total surprise. R2R stated R2R did not think Resident 2 was ready for discharge from the facility. R2R stated no home health RN, OT, PT visits were arranged. R2R stated R2R tried to call Resident 2's health insurance company (HIC), but the HIC staff would not talk to R2R and release any information, stating the HIC staff would need to speak with Resident 2. R2R stated R2R needed to explain to HIC staff that Resident 2 was nonverbal, and R2R had the Power of Attorney documents on file as she was the legal decisionmaker for Resident 2. R2R stated R2R was frustrated due to the runaround.

555737

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 555737 B.

Wing 07/18/2024

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

Bayshire San Dimas Post-Acute 1740 S San Dimas Ave San Dimas, CA 91773

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 DIMAS, 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 BAYSHIRE SAN DIMAS POST-ACUTE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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