Extended Care Hospital of Riverside

In the surveyor’s words

From the most serious findings on record at Extended Care Hospital of Riverside, in the surveyor’s own words.

• No harm, potential for more than minimal, widespreadF812Jun 10, 2022

  Based on observation, interview and record review, the facility failed to store, prepare, and distribute food in accordance with professional standards for food service safety when: 1. The ice machine was not cleaned and sanitized properly per manufacturer's guidance; 2. Three various sizes of cooking pans, readily available for use, had a dry and heavy black substance buildup on the cooking surfaces, and 3. Several various size of metal pans were stacked and stored wet. These failures had the potential to cause food-borne illness in a medically vulnerable resident population who consumed food from the kitchen in the facility. The facility census was 79. Findings: 1. […]

• No harm, potential for more than minimal, patternF689Feb 13, 2026

  Based on observation, interview, and record review, the facility failed to ensure an environment free of accident hazards and to ensure resident receives adequate supervision and assistance devices, for three of three residents reviewed for accidents (Residents 34, 85 and 24) when:1.Resident 34 was found to have cigarettes and a lighter at bedside. This failure had the potential to place Resident 34 and other residents at risk for harm and injuries.2.Resident 85 did not receive adequate supervision and effective fall prevention interventions.This failure resulted in Resident 85 sustaining a fall with facial injuries requiring hospital transfer. […]

• No harm, potential for more than minimal, patternF755Feb 13, 2026

  Based on observation, interview, and record review, the facility failed to ensure: 1. Physician orders with parameters were followed when medications were administered without documenting the systolic blood pressure for one of three residents reviewed after medication pass observation. This failure had the potential for residents to inadvertently receive medications when they need to be held according to the physician's orders. 2. medications contained in the medication carts were not discontinued or discharged and not stored in the cart along with active residents' medications. This failure had the potential for discontinued medications to be used as not intended; 3. […]

• No harm, potential for more than minimal, patternF684Aug 4, 2025

  Based on observation, interview, and record review, the facility failed to ensure care and treatment were provided for four of seven residents reviewed (Residents 1, 4, 5, and 6) when:1. For Resident 1, the licensed nurses did not timely assess and monitor the resident who experienced a change in condition on June 16, 2025. This failure resulted in the hospitalization of Resident 1 on June 20, 2025, with a diagnosis of urinary tract infection (an infection that occurs in any part of the urinary system [how the body gets rid of extra water and waste]). 2. For Residents 4, 5, and 6, peripheral intravenous (IV - administration of fluids or medication through the vein) sites were not documented as assessed or changed for the duration of the admission. […]

• No harm, potential for more than minimal, patternF565Feb 5, 2025

  Based on interview and record review, the facility failed to ensure staff discussed the decisions and the rationale regarding issues or concerns raised by the Resident Council (a group of residents who come together to discuss concerns, make suggestions, and advocate for improvements in their living environment). This failure had the potential to feel that their voices were not heard which could result in dissatisfaction and a decline in quality of life. Findings: On January 22, 2025, at 5:25 p.m., during an interview with Resident 1, she stated the dining room/activity room closes at 7 p.m. and reopens at 9 a.m. […]