Health inspection·January 21, 2025

F 0569 Notify each resident of certain balances and convey resident funds upon discharge, eviction, or death. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility staff failed to ensure funds were returned to social security after a resident was discharged from the facility for one of three sampled residents (Resident 1). Residents Affected - Few This deficient practice resulted in the Business Office Manager (BOM) not refunding social security funds back within three business days as indicated per the facility ' s Policy and Procedure (P&P) titled, Links Healthcare Resident Trust Policy. Findings: During a review of Resident 1 ' s, admission Record (Face Sheet), the Face Sheet indicated Resident 1 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including metabolic encephalopathy (temporary or permanent damage to the brain due to lack of glucose, oxygen or other metabolic agent, or organ dysfunction), chronic obstructive pulmonary disease ([COPD] a chronic lung disease causing difficulty in breathing), and type 2 diabetes mellitus ([DM] a disorder characterized by difficulty in blood sugar control and poor wound healing. During a review of Resident 1 ' s History and Physical (H&P), dated on 5/21/2024, the H&P indicated Resident 1 did not have the capacity to understand and make decisions. During a review of Resident 1 ' s Minimum Data Set ([MDS] a federally mandated resident assessment tool), dated 8/25/2024, the MDS indicated Resident 1 had severe cognitive (though process) impairment. During a review of Resident 1 ' s Physicians Order, dated on 9/3/2024, the Physician ' s Order indicated to transfer Resident 1 to a General Acute Care Hospital (GACH) due to oxygen desaturation (low oxygen level in the blood). During a review of Resident 1 ' s Physician ' s Order dated on 9/3/2024, the Physician ' s Order indicated to place Resident 1 ' s bed on a seven-day bed hold (a resident ' s right to keep a bed vacant and available for seven days after their transfer to the hospital in anticipation of their return to the facility) if Resident 1 was admitted to the hospital. As of 1/16/2025, Resident 1 has not returned to the facility. During a phone interview with Resident 1 ' s Family Member (FM) 1, on 1/16/2025 at 9:51 a.m., FM 1 stated she had been requesting Resident 1 ' s funds from the facility since Resident 1 was (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: 055297 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 055297 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/21/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Springs Post-Acute 10625 Leffingwell Road Norwalk, CA 90650 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)