Health inspection·July 29, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the Care Plan (a document that outlines how a resident will receive support and care to meet their needs) was resident centered (treating each resident as an individual with unique preferences and requirements) for one (1) of two (2) sampled residents (Resident 1) by failing to include Resident 1 requires a 2-person assistance with Activities of Daily Living (ADLsactivities such as bathing, dressing and toileting a person performs daily). These deficient practices have the potential for Residents 1 not to receive care and interventions specific to the resident's needs which could affect the resident's overall wellbeing. Findings:During a review of Resident 1's admission Record, the admission Record indicated the resident was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses that included quadriplegia (paralysis from the neck down, including legs, and arms, usually due to a spinal cord injury) and multiple sclerosis (MS- a chronic, progressive disease involving damage to the nerve cells in the brain and spinal cord).During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool), dated 7/17/2025, the MDS indicated Resident 1 had an intact cognitive (mental action or process of acquiring knowledge and understanding) skills for daily decision making. The MDS also indicated Resident 1 was dependent (helper does all the effort and the assistance of 2 or more helpers is required for the resident to complete the activity) with eating, oral, toileting and personal hygiene, shower, upper and lower body dressing, and putting on and taking off footwear.During an interview on 7/29/2025 at 8:33 AM, the Director of Staff Development (DSD) stated, Resident 1 was assigned with 2 Certified Nursing Assistants (CNAs) and should always have 2 facility staff to help the resident with mobility (ability to move around and perform physical activities) and transfers (the act of moving from one surface to another) for the resident's safety.During a concurrent interview and record review on 7/29/2025 at 2:28 PM with Licensed Vocational Nurse 1 (LVN 1), Resident 1's Care Plan for Potential for increased muscle stiffness, numbness, spasms, weakness of limbs, etc. dated 7/17/2025 was reviewed. The Care Plan indicated to assist resident with mobility and ADLs daily. The Care Plan did not indicate Resident 1 required 2-person assistance with ADLs. (LVN 1 stated Resident 1 required 2- person assistance and that the resident was dependent on ADLs. LVN 1 also stated Resident 1's Care Plan for Potential for increased muscle stiffness, numbness, spasms, weakness of limbs, etc. should be more detailed to reflect the 2-person assistance the resident required during ADLS. LVN 1 further stated Resident 1's Care Plan should be specific to Resident 1 in case a different nurse was assigned, then he/she would have a better understanding of the care required for the resident.During a concurrent interview and record review with the Director of Nursing (DON) on 7/29/2025 at 2:50 PM, Resident 1's Care Plan for Potential for increased muscle stiffness, numbness, spasms, weakness of limbs, etc. dated 7/17/2025 was reviewed. The DON stated Resident 1's Care Plan needs to be resident specific and indicate Resident 1's needs 2-person assistance with ADLS Page 1 of 2 055203 055203 07/29/2025 Sunny Village Care Center 1428 S. Marengo Ave. Alhambra, CA 91803

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few (eating, oral, toileting and personal hygiene, shower, upper and lower body dressing, and putting on and taking off footwear). Resident 1 should be always assisted by 2 staff and is communicated through the Care Plan to maintain a safe and hazard-free environment for Resident 1During a review of the facility's Policy and Procedure (P&P) titled, Care Plans, Comprehensive Person-Centered (focusing on what matters most to the individual receiving care, not just their medical needs), revised March 2022, indicated that a comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial, and functional needs is developed and implemented for each resident. The P&P also indicated that the comprehensive, person-centered care plan describes the services that are to be furnished to attain or maintain the residents' highest practicable physical, mental, and psychosocial well-being. 055203 Page 2 of 2