Health inspection·November 26, 2025

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, and record review, the facility failed to ensure licensing staffs are competent with the knowledge of use of continuous Brand 1 glucose (blood sugar) monitoring systems, [(CGM), a continuous glucose monitoring system helps adults and children ages 2 years and older living with diabetes (a condition that happens when your blood sugar is too high), keep track of their glucose levels in real-time without finger sticks, (a quick, at-home method to get a small capillary blood sample by pricking a fingertip with a sterile lancet for tests of blood sugar)] for one (1) of one (1) sampled resident (Resident 1) This deficient practice had the potential to result in failure of monitoring of Resident 1's blood sugar, this can cause abnormal blood sugar ranging level, with the possibility of damage nerves, blood vessels, and vital organs due to persistently high blood sugar levels. This failure can also cause care team to make inappropriate medical decisions and inappropriate care plans to Resident 1. Findings: During a review of Resident 1's admission Record indicated Resident 1 was admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses that included type 2 diabetes mellitus with unspecified complications (a chronic condition that happens when you have persistently high blood sugar levels that resulted in kidneys damaged and the kidneys are not function properly), unspecified systolic heart failure ( a long-term condition in which your heart can't pump blood well enough to meet your body's needs), presence of cardiac pacemaker (an electronic device that is implanted in the body to monitor heart rate and rhythm). During a review of Physician Order dated 12/26/2024 indicated Resident 1 to apply CGM and change every 10 days. During a review of Resident 1's Quarterly Minimum Data Set, (MDS- a resident assessment tool) dated 10/31/2025, MDS indicated Resident 1 had no cognitive impairment, (resident has normal thinking and memory, and their cognition is intact, and residents make good decisions). The MDS also indicated, Resident 1 is independent, (resident completes the activity by themselves with no assistance from a helper) with eating, oral hygiene, toileting hygiene, upper and lower body dressing, putting on or taking off footwear and personal hygiene. Resident 1 needs partial, moderate assistants (helper does less than half of the effort) for shower and bathe self. During a review of the facility's Education/Training Attendance Roster dated 10/15/2025, it indicated Director of Nurses (DON) started her in service training to licensed nurses for how to apply CGM device, but there was no training for programming the CGM device to the receiver (a portable device that displays a real-time glucose readings from a CGM sensor, showing trends, highs, lows, and sending alerts, acting as an alternative to using a smartphone), and smart phone {[a mobile phone that performs many of the functions of a computer, typically having a touchscreen interface, internet access, and an operating system capable of running downloaded application, (app), a shortened term for a type of software, especially a program designed to run on a mobile device like a smartphone or tablet, that perform a specific function]}. During a concurrent interview and record review on 11/25/2025 at 4:40 PM with Director of Nurses (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: 055203 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 055203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunny Village Care Center 1428 S. Marengo Ave. Alhambra, CA 91803 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)