Health inspection·May 22, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on interview and record review, the facility failed to ensure the Interdisciplinary Team (IDT, a group of health care professionals with various areas of expertise who work together toward the goals of the resident) Falls Committee met to review and document findings and interventions addressing the resident's falls on 4/19 and 4/22/2025 for one of two sampled residents (Resident 2) These failures had the potential to result in Resident 2 sustaining injury and/or harm due to falling while in the care of the facility. Findings: During a review of Resident 2's admission Record (AR), the AR indicated the facility admitted Resident 2 on 3/27/2025 with diagnoses including type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar), muscle weakness, and schizophrenia (a disorder that affects a person's ability to think, feel, and behave clearly). During a review of Resident 2's Minimum Data Set (MDS, a resident assessment tool), dated 3/31/2025, the MDS indicated Resident 1 had no impairment in cognitive skills (ability to make daily decisions). The MDS indicated Resident 1 required substantial/maximal assistance (helper does more than half the effort) from staff for bathing, lower body dressing, and toileting hygiene. During a review of the facility's (Facility) Falling Star (FL, Falls List), updated 5/16/2025, the FL indicated Resident 2 fell while in the care of the facility on 4/19/2025 and 4/22/2025. During an interview on 5/22/2025 at 10:42 a.m. with Resident 2, Resident 2 stated Resident 2 fell twice while residing at the facility. Resident 2 stated both falls happened when Resident 2 fell asleep in the wheelchair. During a concurrent interview and record review on 5/22/2025 at 2:10 p.m. with the Director of Nursing (DON), Resident 2's Change in Condition Evaluation (COC) dated 4/19 and 4/22/2025 and Resident 2's Progress Notes (PN), dated 5/22/2025 were reviewed. The COCs indicated Resident 2 fell on 4/19/2025 and 4/22/2025. The DON stated whenever a resident (in general) experienced a fall, part of the facility's fall management program included that the IDT meet after the fall to evaluate what interventions needed to be implemented to prevent further falls from occurring. The DON stated the IDT meeting would be documented in the residents (in general) Progress Notes or an IDT Assessment Form. The DON confirmed Resident 2's progress notes (PN) did not indicate the IDT met to address Resident 2's falls on 4/19/2025 and 4/22/2025. The DON stated the IDT did not meet following Resident 2's falls since the IDT meeting was not documented in Resident 2's medical record. (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: 055202 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 055202 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rosemead Healthcare Center 4096 Easy Street El Monte, CA 91731 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)