Stanford Court Skilled Nursing & Rehab Center
STANFORD COURT SKILLED NURSING & REHAB CENTER in SANTEE, CA — inspection on August 2, 2024.
Found 16 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.
Inspection Findings
During an observation and interview on 7/30/24, at 8:57 A.M., Resident 178 was in bed and stated the morning staff told her to, Go ahead and pee on the diaper and I'll change you.
During another interview with Resident 178 on 8/1/24, at 9:32 A.M., Resident 178 stated she felt, Terrible when she was told to urinate in the diaper. Resident 178 further stated she did not know if the person was a certified nurse assistant (CNA) or a licensed nurse (LN).
An interview was conducted on 8/1/24, at 9:43 A.M. with CNA 11. CNA 11 stated Resident 178 used the bedpan and was continent with urination. CNA 11 further stated a bedpan was offered to residents who were not able to walk.
An interview was conducted on 8/1/24, at 2:18 P.M. with CNA 12. CNA 12 stated if a resident requested to go to the bathroom, the resident will be assisted right away. CNA 12 further stated if the resident had a wet diaper, this would create skin irritation, redness and smell.
During an interview on 8/2/24, at 12:59 P.M. with the Director of Nurses (DON), the DON stated residents should not be told to urinate in the diaper.
The DON stated residents were admitted to the facility for rehabilitation and to restore previous activity of daily living (ADL- basic tasks of everyday life).
The DON further stated it was demeaning for a resident to be told to urinate on the diaper.
A review of an undated care plan for Resident 178 indicated, ADL Self-Care Performance Deficit. At risk for altered ADL self care performance r/t (related to) requires assist .toileting .Provide appropriate self performance and support needed during ADL care .
During a review of the facility's policy and procedure titled Dignity, dated June 16, 2016, the policy indicated, .Each resident shall be cared for in a manner that promotes and enhances quality of life, dignity, respect and individuality .{Treated with dignity} means the resident will be assisted in maintaining and enhancing his or her self-esteem and self-worth .
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that reflect a personalized, homelike setting.
These characteristics include: .a. clean, sanitary, and
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Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071
During an interview with the Director of Nurses (DON) on 8/2/24, at 12:59 P.M., the DON stated Resident 23's PASARR should have been re-evaluated.
The DON further stated she expected the case manager to review PASARRs from the hospital for residents to receive proper care and to coordinate a different placement if needed.
A review of the facility's undated policy and procedure (P&P) titled, Preadmission Screening Resident Review (PASRR) was reviewed.
The P&P indicated, .If a recipient is found to be mentally ill or mentally retarded, the screening helps determine whether NF (nursing facility) care is appropriate or whether the recipient needs specialized services .
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treatment orders for Triamcinolone and/or an evaluation conducted on Resident 47 for a
On 8/1/24 at 1:34 P.M., a concurrent interview and record review was conducted with licensed nurse
medications and need MD orders. LN 1 stated that treatment creams and/or ointments (semi- solid, greasy substances used on the skin) should be stored in a safe and sanitary (clean) manner in the treatment cart. LN 1 reviewed Resident 47's clinical record and stated Resident 47 was not evaluated for self-administration for triamcinolone ointment nor was there a current MD order. LN 1 stated that Resident 47's triamcinolone cream should not have been left out in the open on top of his nightstand and should have been discarded properly since there was no treatment order for the triamcinolone ointment. LN 1 stated that it was important to have a current MD order for Resident 47 to prevent any allergic reactions.
On 8/1/24 at 2:57 P.M., a concurrent interview and record review was conducted with the Director of Staff Development (DSD).
The DSD stated that triamcinolone is a prescribed treatment that needed to be ordered by an MD.
The DSD stated that all LN's are responsible to make sure medications and treatments are confirmed with the MD to make sure an order is indicated or not.
The DSD stated that Resident 47's triamcinolone ointment should not have been left on Resident 47's nightstand table.
The DSD stated that if the ointment was ordered, it needed to be kept in the treatment cart or thrown away to avoid any cross-contamination or mistakenly used on his roommate.
On 8/2/24 at 8:57 A.M., an interview was conducted with the DON.
The DON stated that all treatments should be treated like medications and required MD orders.
The DON stated that her expectations was for the nursing staff to discard any non-prescribed treatments appropriately and not be easily accessible for use to prevent complications such as severe skin reactions.
Per the facility's policy and procedure titled PHYSICIAN MEDICATION ORDERS dated November 2017 indicated, POLICY STATEMENT Medications shall be administered only upon the written order of a person duly licensed and authorized to prescribe such medications in this state. GUIDELINES 1. No drugs or biologicals shall be administered except upon the order of a person lawfully authorized to prescribe for and treat human illness.
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and hand hygiene for Resident 15's hands should have been done. RNA 1 stated, Her [Resident 15]
On 8/1/24 at 2:25 P.M., an observation and interview was conducted with RNA 1 and Resident 15, in
splint after her shower from 7/31/24. Resident 15 stated, Hurting a bit when RNA 1 moved her hand to remove the splints due to the stretching. Resident 15's left hand was mildly reddened on the inside palm. Resident 15's fingernails on both hands remained long, thick, yellowish brown with brown dirt-like debris underneath her nailbeds with old chipped brownish red nail polish on the tip of the fingernails. RNA 1 stated Resident 15's left hand splint should have been removed yesterday according to the Physician's order.
On 8/1/24 at 2:57 P.M., an interview and record review was conducted with the Director of Staff Development (DSD).
The DSD stated it did not look like Resident 15 was provided with sufficient nail care for both her hands because it, Should not be long and dirty.
On 8/2/24 at 9:31 A.M., an interview was conducted with the Director of Nursing (DON).
The DON stated that Resident 15 did not look like she was getting appropriate nail care for both hands.
The DON stated Resident 15 should receive quality nail care to include trimmed and clean nails.
The facility policy and procedure titled FINGERNAILS/TOENAILS, CARE OF revised, February 2018 indicated, .The purpose of this procedure are to clean the nail bed, to keep nails trimmed and to prevent infections .General Guidelines 1.
Nail care includes daily cleaning and regular trimming .
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Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071
During a review of the facility's policy and procedure (P&P) titled, Percutaneous (Pigtail) Drain, Care of, dated, October 2021, the P&P indicated, .The pigtail drain operates on the principle of negative pressure.
Compression must be maintained on the bulb/accordion for suction to be preserved .
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prescribed medication for pain and should not been stored at her bedside unattended because no
away properly to preserve the effectiveness of the medication.
On [DATE] at 02:57 P.M., an interview and record review was conducted with the Director of Staff Development (DSD).
The DSD stated Resident 30 had current orders for Salonpas for pain and should be stored in the medication cart.
The DSD confirmed that Resident 30 did not have a self-administration safety screen for Salonpas and therefore should not be at Resident 30's bedside.
On [DATE] at 8:57 A.M., an interview was conducted with the Director of Nursing (DON).
The DON stated if Resident 30 was not evaluated for self-administration safety for Salonpas that it should be stored in the medication cart.
The DON stated any prescribed medication orders should be stored safely and securely to prevent misuse and preserve the effectiveness of medications.
The DON stated complications could include severe allergic side effects if not safely monitored and administered.
The facility policy and procedure titled MEDICATION LABELING AND STORAGE revised, February 2023 indicated, POLICY heading [sic] The facility stores all medications and biologicals in locked compartments under proper temperature, humidity and light controls.
Only authorized personnel have access to keys.
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Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071
During a dining observation and interview on 07/31/24 at 10:30 A.M. to 12:00 P.M., with residents in their rooms due to a COVID outbreak at the facility.
Resident food concerns addressed included: Pureed is not good its tasteless.
Food is terrible . meat was Subgrade .had to eat it .to survive.
Too many times they always serve chicken, but I eat it.
Meals aren't that good really. I eat a lot when my daughter brings me food.
Review of the facility's menu dated 7/31/24 indicated the Regular Diet was served pot roast, brown gravy, cheddar mashed potatoes, green peas, devils food cake, milk and beverage of choice.
The Pureed Diet was served pureed pot roast, cheddar mashed potatoes with gravy, pureed carrots, pureed devils food cake, milk and beverage of choice.
On 7/31/24 at 11:58 A.M., a test tray observation and interview was conducted with the Dietary Supervisor (DS), for two test trays (Pureed and Regular).
The DS stated that pureed carrots did not taste like carrots because of the recipe they [kitchen staff] followed and was mixed with broth.
The DS stated that the pureed pot roast tasted salty due to the ingredients.
The DS agreed that the pureed and regular dessert was bland.
On 8/1/24 at 10:43 A.M., an interview was conducted with the DS and the Registered Dietician (RD), in the kitchen.
The DS stated that they would contact their nutritional consultant for a more streamlined menu for food options regarding resident complaints with the same menu items.
The RD stated, Peas and pureed carrots both have different nutritional equivalency.
The RD stated they would look at a different menu system that can provide a better nutritional menu equivalency for the different meal textures because residents should get what goes out on the monthly planned menu.
The RD stated if residents are not eating enough because of palatability (tasteful) that this can cause a potential for weight loss amongst the residents.
Per the facility's policy titled TASTE TESTING, dated 2017, the policy indicated .All food not passing the taste test due to seasoning, toughness, color, or other negative factors will not be served until the problem has been corrected.
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serve food in accordance with professional standards.
sanitary (free of bacteria and other germs that is can be hazardous to humans) practices according to
This failure had the potential to cause widespread food borne illness among all 90 residents who received food from the kitchen.
Findings
On 8/1/24 at 10:00 A.M., an observation and interview was conducted with the Dietary Assistant (DA) 1, in the kitchen. A low-temperature dishwashing machine was being used by DA 1 to clean two crates of dishes that contained trays, cups, dishes and utensils used by the residents in the facility.
DA 1 stated that the temperature gauge for the low-temperature dishwashing machine read 111°F and stated, Anything below 120°F I would report to my boss. DA 1 stated, It would need to be 120°F due to germs and bacteria that can still be on the dishes. DA 1 continued to use the low-temperature dishwashing machine to wash another crate of dirty dishes and did not notify her supervisor. DA 1 stated that if the temperature was low and not reaching the right temperature that the low-temperature dishwashing machine should not be used. DA 1 stated using the low-temperature dishwashing machine was the only method they (kitchen staff) used to wash dirty dishes.
On 8/1/24 at 10:12 A.M., an interview and observation was conducted with the Dietary Assistant (DA) 2, in the kitchen. DA 2 stated that the low-temperature dishwashing machine gauge read 111°F and that the low-temperature dishwashing machine needed to be at 120°F to remove, The stains and germs from dirty dishes. DA 2 stated if the temperature is not at 120°F they would need to wait until they fixed the, Issue to use the low-temperature dishwashing machine. DA 2 stated, People would get sick if not washed properly. DA 2 stated if the low-temperature dishwasher was broken he was unsure if they had another plan to clean the dishes.
On 8/1/24 at 10:17 A.M., an interview was conducted with the Dietary Supervisor (DS).
The DS stated that his expectations were for the staff to notify him when a machine was not working properly and that the staff was expected to know to use the three compartments sink to wash dirty dishes and air dried.
The DS stated DA 1 did not properly sanitize the dirty dishes when the temperature read 111°F and should have stopped using the low-temperature dishwashing machine to continue washing dirty dishes.
The DS further stated DA 1 should not have put the dishes away with the clean dishes because it was not fully sanitized and puts the residents at risk for foodborne illnesses.
Per the facility's policy and procedure titled RESOURCE: SANITATION OF DISHES/DISH MACHINE dated 2017 indicated, .Low Temperature Dishwasher .Wash temperature 120°F .
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Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071
food items such as a sandwich wrapped in a plastic wrap in a container without a lid, chocolate
nightstand. Resident 47 stated that he did not like the food at the facility and that his wife brought all
On 8/01/24 at 1:34 P.M., an interview was conducted with LN 1, at the west wing nursing station. LN 1 stated that they store outside food items brought by visitors and family to a resident needed to be stored in a refrigerator located in the east wing. LN 1 stated it was not appropriate to have Resident 47's food items stored and unlabeled at his bedside. LN 1 stated that Resident 47's food items that were placed on the nightstand which included a sandwich, chocolate pastries, and a banana are all perishable (foods that can spoil easily without proper storage) and should have been labeled, stored in a refrigerator, or discarded. LN 1 stated since the food items were not labeled and not stored properly it was best to discard the food items to prevent any food-borne illnesses.
On 8/1/24 at 2:57 P.M., an interview was conducted with the Director of Staff Development (DSD).
The DSD stated Resident 47's sandwich and chocolate pastries should be stored in a tight-fitting container with a lid with a label and dated.
The DSD stated that Resident 47's food items should be stored appropriately in the residents' fridge located in the East wing nursing station should the food be consumed at a later time.
The DSD stated if food items are not labeled then the nursing staff would need to discard it right away to prevent attracting pests that can carry infection and the consumption of spoiled foods that could lead to food-borne illnesses.
On 8/2/24 at 8:57 P.M., an interview was conducted with the Director of Nursing (DON).
The DON stated foods should not be on stored at Resident 47's bedside.
The DON stated outside food items should be labeled to prevent spoilage and stored properly in tight fitting containers with lids to prevent attracting pests from contaminating food items that are harmful to all the facility residents and to prevent the consumption of spoiled foods to prevent food-borne illnesses.
Per the facility's policy and procedure titled FOOD BROUGHT by FAMILY/VISITORS dated, March 2022 indicated, .
Policy and Interpretation and Implementation .4.
Safe food handling practices are explained to the family/visitors in a language and format that they understand .5.
Food brought by family/visitors that is left with the resident to consume later is labeled and stored in a manner that it is clearly distinguishable from facility-prepared food a.
Non-perishable foods are stored in re-sealable containers with tightly fitting lids b.
Perishable foods are stored in re-sealable containers with tightly fitting lids in a refrigerator.
Containers are labeled with the resident's name, the item and the use by date .
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she was made aware of the fruits found in Resident 58's room on 7/30/24.
The DON stated she took
staff to know what kind of precautions Residents 58's required, and what personal protective
A record review of Resident 58's admission orders dated 9/23/2023 indicated .Neutropenic precautions related to malignant neoplasm of endometrium, indicated no outside food, plants, and flowers .
A review of the facility's Neutropenic Precautions policy and procedure dated April 2018 .precautions continued .#4 plants and flowers shall be removed from the resident room . dietary concerns .#2 raw and partially cooked meat, vegetables and fruits are prohibited .miscellaneous .#3 family members and visitors may be required to wash their hands, put gown on and wear mask .
During an observation and interview on 7/30/24, at 8:42 A.M. with Resident 177, Resident 177 was sitting on a wheelchair and showed a tube with an accordion bulb connected to a drainage bag. Resident 177 stated the drain was due to an abscess and the staff did not properly took care of it. Resident 177 stated it has been two days that the accordion bulb was not squeezed (squeezed - to apply suction to drain the fluid).
The accordion bulb was observed with small amount of brown fluid, and the accordion bulb was not squeezed.
On 7/31/24, at 12:27 P.M. Resident 177 was sitting up in the wheelchair.
The drainage tube was observed hanging on Resident 177's left side with accordion bulb which was not squeezed.
During a review of physician's orders (POS) for Resident 177, the POS with start date of 7/24/24 indicated, . IR Drain insertion site Site: Left buttocks monitor for drainage, pain and s/sx (signs and symptoms) of infection until healed .
During an interview on 8/1/24, at 10:32 A.M. with licensed nurse (LN) 14, LN 14 stated Resident 177 had a drain on the left buttock due to diverticulitis (small and inflamed pouches that forms in the wall of the large intestine), and the treatment nurse provided care of the drainage tube.
During an interview on 8/1/24, at 1:34 P.M. with the treatment nurse (TN), the TN stated she changed Resident 177's drainage tube site dressing, then squeezed the accordion bulb for fluid to drain.
The TN further stated the accordion bulb must be squeezed to create suction and drain fluid.
On 8/1/24, at 1:41 P.M. an interview was conducted with LN 11. LN 11 stated she covered for the TN when TN was off. LN 11 stated she flushed Resident 177's drainage tube and covered the site with a dressing. LN 11 stated the drain worked by gravity and the accordion bulb did not have to be squeezed. LN 11 further stated the accordion bulb was squeezed only upon emptying of the drainage bag.
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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 555290 B.
Wing 08/02/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071
Findings
Review of Resident 15's clinical record indicated Resident 15 was readmitted on [DATE] with diagnoses which included a history of hemiplegia (one sided muscle weakness) and hemiparesis (inability to move one side of the body) following cerebral infarction affecting left dominant side (a brain attack known as a stroke that stops blood flow to the brain causing left sided weakness and movement to the body) per the facility's Admission Record.
A record review of Resident 15's minimum data set (MDS: a nursing assessment tool) dated 7/18/24 indicated a Brief Interview for Mental Status (BIMS- developed by reviewing the resident's mental status during the prior seven-day period) score of 15 points out of 15 possible points which indicated Resident 15 had no cognitive (pertaining to memory, judgement, and reasoning ability) deficits.
A record review of Resident 15's MDS dated [DATE], indicated that Resident 15's functional abilities status with personal hygiene (the ability to maintain personal hygiene, including combing hair, shaving, applying makeup, washing/drying face and hands) was dependent.
On 7/31/24 at 10:39 A.M., an observation and interview was conducted with Resident 15, in Resident 15's room. Resident 15 was seen lying in bed resting with a left-hand contracture without a hand splint. Resident 15's fingernails on both hands were long, thick, yellowish brown with brown dirt-like debris (accumulation of waste and/or dead skin) underneath her nailbeds with old chipped brownish red nail polish on the tip of the fingernails. Resident 15 stated that the staff puts on her hand splint only when they thought of doing so. Resident 15 stated she did not remember the last time they put on the hand splint or provided nail care.
On 8/1/24 at 8:53 A.M., an observation and interview was conducted with Resident 15, in Resident 15's room. Resident 15 was observed with a hand splint to her left contracted hand. Resident 15's fingernails on both hands were long, thick, yellowish brown with brown dirt-like debris underneath her nailbeds and old chipped brownish red nail polish on the tip of the fingernails. Resident 15 stated the nursing staff did not provide nail care for her.
555290
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 555290 B.
Wing 08/02/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071
Findings
Review of Resident 58's Admission Record indicated Resident 58 was admitted to the facility on [DATE] with diagnoses that included Malignant Neoplasm of Endometrium (cancer of uterus).
On 7/30/24 at 9:20 A.M., an observation of Resident 58's room was conducted. Resident 58's door had signage which indicated Resident 58 was on neutropenic precautions.
On 7/30/24 at 9:25 A.M., an interview with Resident 58's roommate (Resident 59) was conducted. Resident 59's bedside table had a basket of raw fruits which consisted of apples and oranges. Resident 59 stated her daughter brought in the basket of fruits few weeks ago and left them on her bedside table. Resident 59 stated a supervisor from the facility took them out yesterday after the State saw the basket of raw fruits. Resident 59 stated she did not realize the raw fruits were not allowed in the room.
On 8/2/24 at 9:30 A.M., an interview with Certified Nursing Assistant (CNA) 23 was conducted. CNA 23 stated Resident 58 was on neutropenic precautions to protect her from outside germs brought in by staff and visitors since Resident 58 was prone to infection. CNA 23 stated staff must gown up before entering Resident 58 's room and do hand hygiene. CNA 23 stated flowers were allowed in Resident 58's room, same with fruits and vegetables if they have been washed. CNA 23 stated visitors must gown up too but often they did not.
On 8/2/24 at 9:57 A.M., an interview with licensed nurse (LN) 21 was conducted. LN 21 stated staff needed to wear mask, gown and gloves when entering Resident 58's room. LN 21 stated the facility does laboratory work to monitor Resident 58's white blood cell to ensure Resident 58 was protected from infection.
On 8/2/24 at 10:02 A.M., an interview with LN 22 was conducted. LN 22 stated Resident 58 was on neutropenic isolation due a low white blood cell count. LN 22 stated staff needed to gown up and wear mask prior to entering Resident 58's room. LN 22 stated that was done to protect Resident 58 from infection. LN 22 stated there should be no fresh or raw fruits, vegetables, or flowers in Resident 58's room. LN 22 stated Resident 58's visitors were advised to gown up and are not allowed to bring fruits, vegetables, and flowers of any kind.
555290
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 555290 B.
Wing 08/02/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071
Review of Resident 59's clinical record indicated Resident 59 was readmitted on [DATE] with diagnoses which included a history of hemiplegia (one sided muscle weakness) and hemiparesis (inability to move one side of the body) following cerebral infarction affecting left non-dominant side (a brain attack known as a stroke that stops blood flow to the brain causing left sided weakness and movement to the body).
A record review of Resident 59's minimum data set (MDS: a nursing assessment tool) dated 6/3/24, indicated a Brief Interview for Mental Status (BIMS- developed by reviewing the resident's mental status during the prior seven-day period) score of 15 points out of 15 possible points which indicated Resident 47 had no cognitive (pertaining to memory, judgement, and reasoning ability) deficits.
On 7/30/24 at 9:26 A.M., an observation and interview was conducted with Resident 59. Resident 59 had a mesh bag that contained oranges and apples in a clear plastic bag beside fresh flowers on the nightstand to her right. Resident 59 stated she liked fruits and that her daughter had brought over the oranges and apples about a week ago and had been placed there for easy access for when she craved them.
On 8/1/24 at 9:34 A.M., an observation and interview was conducted with Resident 59. Resident 59 stated that the facility had removed her oranges and apples because, They have State here [the facility] and was told by the nursing staff to keep the oranges and apples in the closet. Resident 59 stated that the nursing staff had placed her oranges and apples in her closet so that it was not left out in the open.
555290
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 555290 B.
Wing 08/02/2024
NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE
Stanford Court Skilled Nursing & Rehab Center 8778 Cuyamaca Street Santee, CA 92071
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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.