Health inspection·October 28, 2024

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to readmit one of three sampled residents (Resident 1), who was transferred to a General Acute Care Hospital (GACH) for refusal of care at the facility and was deemed appropriate to return to the facility. This deficient practice placed the resident at risk for confusion and psychosocial harm related to the inability to return to the facility and unnecessary, extended stay at the GACH. Findings: During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including cellulitis (a skin infection that causes swelling and redness) of the buttock and left lower limb, type two diabetes mellitus ([DM[ a disorder characterized by difficulty in blood sugar control), and pressure ulcer (localized, pressure-related damage to the skin and/or underlying tissue usually over a bony prominence) of the right. The admission record indicated Resident 1 was self-responsible. During a review of Resident 1's Initial assessment dated [DATE] at 7:30 p.m., the assessment indicated Resident 1 spoke English, was alert and oriented to person, place, and time (x3), friendly, cooperative and had good motivation toward rehabilitation. The assessment indicated Resident 1 had multiple opened lesions on the left lower extremity due to cellulitis and an unstageable pressure injury on the sacrum (tailbone) area. During a review of Resident 1's Order Summary Report, dated 10/17/2024, the Report indicated Resident 1 was admitted to the facility for skilled nursing services. The Report indicated administer Cephalexin (medication to treat infection) 500 milligrams ([mg] a unit of measurement) three (3) times a day for 14 days (until 10/31/2024), for cellulitis of the left lower extremity and Flagyl (medication to treat infection) 500 mg, 1 tablet every 12 hours until 10/30/2024 for cellulitis of the lower extremity. The Report indicated Resident 1 may have rehabilitation (process that helps people regain or improve physical abilities needed for daily life) screening upon admission. The Report did not any wound care orders for Resident 1. During a review of Resident 1's PT (Physical Therapy) Evaluation and Plan of Treatment dated, 10/18/2024, the PT Plan of Treatment indicated resident 1 was bitten by a pit bulldog and had extensive wound to his leg. The Plan of Treatment indicated Resident 1 did not test for ambulation (walking) due to his extensive wound (wound healing) on left leg and its pain at the time of the evaluation. The Plan of Treatment indicated Resident 1 required skilled PT services to increase independence with (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 055045 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055045 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/28/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Riviera Healthcare Center 8203 Telegraph Rd Pico Rivera, CA 90660 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)