Health inspection·July 28, 2023

F 0620 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Not require residents to give up Medicare or Medicaid benefits, or pay privately as a condition of admission; and must tell residents what care they do not provide. Based on interview and record review, the facility failed to follow the admissions policy by requiring one of eight sampled residents (Resident 1) to submit an application for admission packet as a pre-admission condition. This deficient practice has the potential to make all potential residents become automatically ineligible for, Medicare or Medicaid benefits and may also give the facility the ability to dictate how residents or potential residents distribute their assets. Findings: A review of the facility's admission policy titled admission Process. Policy number: 100. last revised 11/18. states that on the day of admission, admitting representative will print computer generated forms and provide newly admitting patient/resident with an admission Packet . A review of the facility's Application for admission (updated 6/17/2019) packet, requires residents to agree to not give away my real and personal properties and monies that I may hold an interest in or have in my possession and I am stating I have not transferred any of my assets for less than full market value within a two year period preceding the date of this application. A review of the facility's Application for admission (updated 6/17/2019) packet, also requires residents to Further, if accepted, I will personally preserve my assets and shall use said assets to pay for my care while I am a patient in the . facility. A review of the 22 CCR regs. Tit. 22, § 72516 (c) Standard admission Agreement., states, No resident or his or her legal representative shall be required to sign any other document at the time of, or as a condition of, admission to the licensee's facility, or as a condition of continued stay in the facility. During an interview and concurrent record review, on 7/27/2023 at 11:23 a.m., with Director of Risk and Regulatory (DRR), Manager of Admitting and Business Office (MABO), LTC Coordinator (LTCC) and Director of Social Services (DSS), DSS stated that all potential residents, as part of the facility admission process, must fill out and submit the facility's Application for admission (updated 6/17/2019) packet in addition to demographic information. DSS1 added the application packet is securely kept in files at the facility pending bed availability while potential residents are added to a waitlist. A review of a letter from the facility's [NAME] President of Legal Affairs (VPLA) dated 8/9/2023, Page 1 of 2 055034 055034 07/28/2023 Motion Picture and T.V. Hosp D/P Snf 23388 Mulholland Dr. Woodland Hills, CA 91364

F 0620 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few VPLA's letter confirmed that the facility's Application for admission (updated 6/17/2019) packet, is filled out in advance by prospective residents as part of the facility's waitlist process. During an interview and concurrent record review, on 7/27/2023 at 11:23 a.m., with Director of Risk and Regulatory (DRR), Manager of Admitting and Business Office (MABO), LTC Coordinator (LTCC) and Director of Social Services (DSS), DSS stated that, upon receipt of the completed facility's Application for admission (updated 6/17/2019) packet, a social worker will contact the potential resident to discuss their financial status, if payment for services at the facility will be via private pay or medi-cal. DSS also added that facility staff will call potential residents to check if there have been changes to their financial and/or medical status when a bed becomes available for admission. During a Microsoft Teams telephone interview and concurrent record review, on 7/28/2023 at 11:39 a.m., with DRR, LTCC and DSS, LTCC stated the facility's Application for admission (updated 6/17/2019) packet, is used by the facility staff to verify if a potential resident will qualify for Medi-Cal based on their guidelines or not. If not, potential residents are then advised about being billed for services. 055034 Page 2 of 2