Health inspection·June 12, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure one of three sampled residents (Resident 1) wore a cranial helmet (prescribed to residents to protect the head after undergoing a craniotomy [surgery that removes a portion of bone from the skull]) as ordered by the physician. Residents Affected - Few This failure placed Resident 1 at risk for injuries, delayed healing and dehiscence (partial or complete separation of the edges of the resident's surgical incision). Findings: During an observation on 6/12/2025 at 7:40 a.m. in Resident 1's room, Resident 1 was observed without a cranial helmet on. During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted on [DATE] with diagnoses including intracerebral hemorrhage (bleeding into the brain tissue), person injured in motor vehicle accident (MVA), traumatic brain injury (TBI- a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head), epilepsy (a sudden, uncontrolled electrical disturbance in the brain which can cause uncontrolled jerking, blank stares, and loss of consciousness), and psychosis (a severe mental condition in which thought, and emotions are so affected that contact is lost with reality). During a review of Resident 1's Physician Orders dated 5/5/2025, the Physician Orders indicated Resident 1 was ordered to always wear a cranial helmet, except during shower times. During a review of Resident 1's Care plan related to Resident 1's alteration in neurological status due to intracerebral hemorrhage, post motor vehicle accident dated 5/5/2025, the Care plan nursing interventions indicated to ensure Resident 1 had his cranial helmet on at all times except during shower times. During a review of Resident 1's History and Physical (H&P) dated 5/6/2025, the H&P indicated Resident 1 had fluctuating capacity to understand and make decisions. The H&P indicated Resident 1 had a history of craniotomy with a surgical wound and staples (surgical closure device) on his head. During a review of Resident 1's Progress Note dated 5/6/2025, the Progress Note indicated Resident 1 was admitted with a surgical incision on the left side of the head measuring 32 centimeters (cm- metric unit of measurement, measures length), by 0.3 cm with 67 staples in place. During a review of Resident 1's Minimum Data Set (MDS – a resident assessment tool) dated (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 2 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 06/12/2025 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)