Health inspection·July 28, 2025

F 0880 Provide and implement an infection prevention and control program. 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 failed to provide a safe and sanitary environment for two (2) out of three (3) sampled residents (Residents 1 and 2) in accordance with the facility's Infection Control and Pet Programs policies. This deficient practice had the potential to put Resident 1 and 2 at risk of being exposed to potential health and safety risks which include infection. During a review of Resident 1's admission Record, the admission Record indicated the resident was admitted to the facility on [DATE] with diagnoses that included type 2 Diabetes (a disease in which your body does not produce enough insulin needed to control sugar levels in the blood), and liver cancer. During a review of Resident 1's History and Physical (H&P) dated 7/21/2025, the H&P indicated that Resident 1 has the capacity to understand and make decisions. During a review of Resident 2's admission Record, the admission Record indicated the resident was admitted to the facility on [DATE] with diagnoses that included dementia (a progressive state of decline in mental abilities). During a review of Resident 2's Minimum Data Set (MDS, a care assessment and screening tool) dated 5/14/2025, the MDS indicated the resident was assessed to have intact cognitive (capable of remembering, learning new things, concentrating, or making decisions that affect everyday life) and required substantial/maximal assistance (helper does more than half the effort) for toileting hygiene, and showering. The MDS also indicated Resident 2 required partial/moderate assistance (helper does less than half the effort) for upper body dressing, lower body dressing, putting on/taking off footwear and personal hygiene. The MDS also indicated Resident 2 required setup or clean up assistance (helper sets up or cleans up) for eating, and oral hygiene. During an interview on 7/28/2025 at 9:42 AM with Certified Nursing Attendant (CNA) 1, CNA 1 stated that CNA 3 would bring a live chicken and baby possum into the facility and invite residents to see the animals. During an interview on 7/28/2025 at 9:50 AM with CNA 2, CNA 2 stated that CNA 3 would bring in a live chicken and put it uncaged on top of a table in a hallway outside of residents' rooms. During an interview on 7/28/2025 at 9:56 AM with Registered Nurse1 (RN1), RN 1 stated, facility staff are not allowed to bring in pets such as live chicken and baby possum because the pets can expose residents to illness/ infection and residents may get sick. During an interview on 7/28/2025 at 10:04 AM with Licensed Vocational Nurse1 (LVN1), LVN 1 stated that CNA 3 would bring in a baby possum and carry it around CAN 3's neck and walk around the facility. LVN 1 stated that CNA 3 brought a possum and chicken into the facility several times (but not able to remember exact dates). LVN 1 stated that animals/ pets such as possum and chicken can carry bacteria and disease to the residents which can infect vulnerable residents. During an interview on 7/28/2025 at 10:11 AM with Resident 1, Resident 1 stated that CNA 3 would bring a live chicken into the facility and place it on a table in the hallway outside of resident rooms. Resident 1 stated that there would be bird feces around the chicken on the table and along the hallway. Resident 1 stated, she felt it was a dirty thing to bring in a live chicken because the droppings can get people sick. During an interview on 7/28/2025 at 10:17 AM with the Residents Affected - Few (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: 055376 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 055376 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Huntington Drive Health and Rehabilitation Center 400 W. Huntinton Dr. Arcadia, CA 91007 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)