Las Alturas de Penitas

In the surveyor’s words

From the most serious findings on record at Las Alturas de Penitas, in the surveyor’s own words.

• Immediate jeopardy, patternF684Jan 26, 2024

  Based on observation, interview and record review, the facility staff failed to ensure residents received treatment and care in accordance with professional standards of practice for 1 of 9 residents (Resident #1) reviewed for quality of care. The facility failed to identify a chnge in condtion for 9 hour for Resident #1, across 2 shifts on 01/14.24. An Immediate Jeopardy (IJ) situation was identified on 01/23/24. While the Immediate Jeopardy was removed on 01/26/24 at 10:36 am, the facility remained out of compliance at a scope of pattern with no actual harm that is immediate, due to the facility's need to evaluate the effectiveness of the corrective systems. […]

• Immediate jeopardy, patternF692Jan 26, 2024

  Based on observation, interview, and record review, the facility failed to ensure acceptable parameters of nutritional status, such as usual body weight or desirable body weight range and electrolyte balance,unless the resident's clinical condition demonstrated that this was not possible, or resident preferences indicate otherwise for one of nine residents reviewed for nutrition. The facility failed to ensure Resident #1 did not sustain a significant weight loss of 18.18% in a 30-day period. An Immediate Jeopardy (IJ) situation was identified on 01/23/24. […]

• Immediate jeopardy, patternF689Dec 18, 2023

  Based on observation, interview, and record review, the facility failed to ensure that each resident received adequate supervision / interventions for 2 residents (Resident #1 and Resident #99) of 5 residents reviewed for supervision / interventions, in that The facility failed to ensure Resident #1, and Resident #99 received supervision and interventions to prevent Resident #1 and Resident #99 from repeated falls with injuries. An Immediate Jeopardy was identified on 12/15/23. The Immediate Jeopardy template was provided to the facility Administrator on 12/15/23 at 04:35 p.m. […]

• Immediate jeopardy, isolatedF600Feb 1, 2025

  Based on interview and record reviews the facility failed to ensure the residents had the right to be free from abuse, neglect, misappropriation of resident property, and exploitation for 3 of 3 residents (Resident #24, Resident #25 and Resident #26) reviewed for abuse. 1. The facility failed to ensure Resident #26 did not inappropriately touch Resident #25 in the groin area, over his clothing, on 02/10/24 . 2. The facility failed to ensure Resident #26 did not inappropriately touch Resident #24 in the breast area on 04/16/24. An Immediate Jeopardy (IJ) situation was identified on 01/30/25. […]

• Immediate jeopardy, isolatedF689Oct 3, 2023

  Based on interview, and record review, the facility failed to ensure services were provided with adequate use of assistive devices to prevent accidents for 1 of 5 residents, Resident #5 (R #5) reviewed for accidents. The facility failed to ensure staff were adequately trained in the use of mechanical lifts needed for resident transfers. CNA C and NAIT D did not ensure mechanical lift sling was properly attached to the lift's hooking mechanism when transferring R #5, resulting in sling releasing from hook and R #5 landing face first on the floor, which caused R #5 to sustain a mild right temporal subdural acute hematoma, interhemispheric subdural hematoma, bilateral nasal bone fractures, left medial orbital fracture, forehead/nasal bridge lacerations, and 9 stitches (8 on top of his left… […]