Health inspection·March 13, 2025

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to implement treatment orders for skin lesions for one of six sampled residents (Resident 3) by failing to: 1. Ensure physician orders were transcribed (putting data into written or printed form) into Resident 3 ' treatment administration record. 2. Ensure skin treatments were documented when it was performed for Resident 3. These deficient practices had the potential to place Resident 3 at risk of not receiving appropriate skin treatment and a delay in communication between licensed staff due to incomplete medical records. Findings: During a review of Resident 3 ' s Face Sheet (front page of the chart that contains a summary of basic information about the resident), the face sheet indicated Resident 3 was admitted to the facility on [DATE] with diagnoses that included Parkinson ' s Disease (a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movements), paranoid schizophrenia (a mental illness that is characterized by disturbances in thought), and systemic involvement of connective tissue (a group of disorders that affect the body's connective tissues, leading to inflammation and damage in organs and tissues). During a review of Resident 3 ' s Minimum Data Set (MDS – a resident assessment tool), dated 3/3/2025, the MDS indicated Resident 3 had severely impaired cognition (ability to reason, understand, remember, judge, and learn). During a review of Resident 3 ' s Wound Assessment and Plan, dated 3/6/2025, The Wound Assessment and Plan indicated for site 1 of the forehead, the treatment order was to paint with betadine every day and as needed. For wound location on site 2 of the forehead, the treatment order was to cleanse wound with normal saline or sterile water, apply xeroform to wound bed and cover with dry clean dressing. For wound location on site 3 of the right ocular region, it indicated to paint with betadine every day and as needed. During a review of Resident 3 ' s Order Summary Report, dated 2/2025- 3/2025, there were no orders placed related to Resident 3 ' s cancer lesions on the forehead and the right ocular region. (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: 055167 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 055167 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vernon Healthcare Center 1037 W. Vernon Avenue Los Angeles, CA 90037 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)