Mount Miguel Covenant Village
Inspection Findings
F-Tag F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
indicated that the CN went to Resident 1's room to assess the resident after the unwitnessed fall. The CN documented that Resident 1 had hit the left side of his head and sustained a bleeding laceration. The CN also documented that Resident 1 was on blood thinner medications. The Clinical Note indicated that Resident 1's bed was raised and the bed rails were not in place. A review of Resident 1's Clinical Notes, dated 7/12/25, indicated that Resident 1's left 4th finger was very red, swollen, warm to touch. The Clinical Note indicated an x-ray of Resident 1's left hand was conducted at the facility which showed an acute comminuted fracture (where the bone breaks into three or more pieces) of the fourth distal phalanx, with associated soft tissue swelling. The Clinical Note indicated Resident 1 was sent to the hospital and was admitted with an infection of the left fourth finger and left upper extremity cellulitis (infection of left upper arm). An interview with CNA 1 was conducted on 8/12/25 at 10:14 A.M. CNA 1 stated that he and the SNA were changing Resident 1 when the roommate's wife yelled out that her husband was vomiting. CNA 1 stated he immediately went to get the nurse and when they returned, Resident 1 had fallen out of bed. CNA 1 stated Resident 1's bed was set in a high position because they were in the middle of changing him. CNA 1 acknowledged that the SNA should not be left alone with the resident, and stated In this event, I should've sent her out instead of myself to reach out for the nurse. On 8/12/25 at 4:06 P.M. the SNA stated during an
interview that she and CNA 1 were changing Resident 1 when the roommate's wife yelled out to get a nurse because her husband was throwing up. CNA 1 then rushed out to get the nurse, but as soon as he left, the resident turned and fell to the ground. The SNA stated that Resident 1 tended to reach for the siderails, which were down at the time. The SNA further stated, It happened really fast.
Event ID:
Facility ID:
If continuation sheet
MOUNT MIGUEL COVENANT VILLAGE in SPRING VALLEY, 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 SPRING VALLEY, 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 MOUNT MIGUEL COVENANT VILLAGE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.