Health inspection·February 11, 2025

F 0880 Provide and implement an infection prevention and control program. 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 implement its policy and procedure (P&P) titled, Enhanced Standard Precautions ([ESP] a framework for reducing multi drug-resistant organism [MDRO] transmission by using gowns and gloves while caring for residents at high risk for MDRO transmission, at the point of care during specific activities, by contmainating health care workers' hands, clothes and the environment), which indicated to don (put on) PPE within room, before engaging in activity (resident care), if splash is anticipated, for two of eight sampled residents (Residents 6 and 7), who had physician ' s orders for wound care. Residents Affected - Few This deficient practice had the potential to result in transmission of a disease-causing organisms, affecting the other residents in the facility, and the potential for the affected residents ' delay in wound healing process. Findings: 1). During a review of Resident 6 ' s admission Record, the admission Record indicated Resident 6 was originally admitted to the facility on [DATE], and re-admitted on [DATE] with diagnoses including muscle weakness (a lack of muscle strength or the inability to control voluntary muscle force) unspecified Dementia (a progressive state of decline in mental abilities) and quadriplegia (a condition characterized by the partial or complete loss of motor and sensory function in all four limbs) of the arms and legs. During a review of Resident 6 ' s History and Physical (H&P) dated 12/13/2024, the H&P indicated Resident 6 did not have the mental capacity to understand and make medical decisions. During a review of Resident 6 ' s Minimum Data Set (MDS – a federally mandated resident assessment tool) dated 12/15/2024, the MDS indicated Resident 6 usually understand and be understood by others. The MDS indicated Resident 6 required substantial to maximum assistance for bed mobility, transfer, walking, eating, personal hygiene and toileting. During a review of Resident 6 ' s physician ' s order dated 1/27/2025, the physician ' s order indicated Resident 6 had a left heel Stage 3 pressure ulcer (deep and painful wounds in the skin). The physician ' s order indicated to cleanse the left heel with antiseptic spray, pat dry and apply santyl (an ointment used to remove damaged tissue from chronic skin ulcers), collagen alginate (type of dressing) then covers with bordered dressing, wrap with kerlix and secure with tape dressing daily, for 30 days. During a concurrent observation and interview on 2/11/2025 at 9:20 a.m. with Licensed Vocational (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: 055072 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 055072 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosecrans Care Center 1140 West Rosecrans Avenue Gardena, CA 90247 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)