Health inspection·July 18, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview and record review, the facility failed to provide reasonable accommodation of needs for one of three sampled residents (Resident 1) by failing to ensure Resident 1 ' s call light (a device with a button or touchpad a resident uses to set off an alarm that flashes/rings to alert the facility staff the resident needs assistance) was within reach as indicated in the facility ' s Policy and Procedures (P&P) titled Call Light Answering revised on 9/11/23. Residents Affected - Few This deficient practice had the potential for Resident 1 not to receive emergency care or have a delay in care and services that could result in a fall or accident. Findings: A review of Resident 1 ' s admission Record indicated the facility admitted the resident on 5/29/2024 with diagnoses that included chronic obstructive pulmonary disease (COPD-a common lung disease causing restricted airflow and breathing problems), acute and chronic respiratory failure (acute respiratory failure-occurs when there is a sudden decrease in the ability to exchange oxygen and carbon dioxide between the lungs and blood stream; chronic respiratory failure occurs gradually and requires longer-term treatment), bronchiectasis (chronic lung condition where the walls of the airways widen and are thickened from inflammation and infection), weakness (state or condition of lacking strength), difficulty walking, and Alzheimer ' s disease (a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks). A review of Resident 1 ' s History and Physical dated 5/30/24, indicated Resident 1 did not have the capacity to understand and make decisions. A review of Resident 1 ' s Minimum Data Set (MDS-a comprehensive assessment and care screening tool) dated 6/2/2024, indicated Resident 1 had severe cognitive (ability to think, read, learn, remember, reason, express thoughts, and make decisions) impairment and was dependent on facility staff with eating, toileting, lower body dressing and putting on/taking off footwear. The MDS indicated the resident needed substantial/maximal assistance (helper does more than half the effort/helper lifts of holds trunk or limbs and provides more than half the effort) with oral hygiene, shower/bathing, upper body dressing, personal hygiene, and indoor mobility (the ability to move freely or purposefully, or to change and control one's body position). A review of Resident 1 ' s care plan initiated on 5/3/23, indicated Resident 1 was at risk for falls related to balance problem when standing/ambulating (walking), gait (the way a person walks or moves on foot, including the coordination of their feet, legs, and arms) disturbance, impaired cognition/poor safety awareness, noncompliance in using call light, use of medication that could affect balance and weakness. The care plan indicated the nurse was tokeep the call light within reach and (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: 055350 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 055350 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Culver West Health Center 4035 Grandview Blvd. Los Angeles, CA 90066 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)