Health inspection·January 17, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to notify one of three sampled resident ' s (Resident 1) resident representative (RR) 1 immediately after Resident 1 sustained a fall and was transferred to a General Acute Care Hospital (GACH) for evaluation. This failure resulted Resident 1 ' s RR 1 not being notified of Resident 1 ' s fall and transfer to the GACH until five hours and 25 minutes later. The deficient practice resulted in violation of the RR 1 ' s right to be informed of Resident 1 ' s care and services provided. 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], with diagnoses including acute cerebrovascular insufficiency (a temporary lack of blood flow to the brain), hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body) affecting left dominant side, abnormalities of gait (a manner of walking on foot) and mobility. During a review of Resident 1 ' s History & Physical (H&P), dated 4/6/2024, the H&P indicated Resident 1 had 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 10/9/2024, the MDS indicated Resident 1 had severe cognitive impairment and was usually able to understand and be understood by others. The MDS indicated Resident 1 required maximal assistance from staff for sit to lying, lying to sitting on side of bed, sit to stand position, and required partial/ moderate assistance from staff for chair to bed and bed to chair transfers. During a review of Resident 1 ' s Progress Notes, dated 1/9/2025, the Progress Notes indicated, on 1/9/2025 at 3:20 p.m., Resident 1 fell and hit the left side of her head on the floor. The Progress Notes indicated Resident 1 was transferred to a GACH for evaluation. During a telephone interview on 1/15/2025 at 2:12 p.m., with RR 1, RR stated RR 2 called the facility on 1/9/2025 around 8 p.m. and was told Resident 1 was not at the facility and was transferred to the GACH. RR 1 stated she and RR 2 were concerned that they were not aware of Resident 1 ' s status and surprised to hear that Resident 1 was not at the facility. RR 1 stated she was upset and frustrated because the facility should have called her immediately after Resident 1 had the fall and was transferred to the GACH on 1/9/2025. (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 4 Event ID: 055387 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 055387 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/17/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Edgewater Skilled Nursing Center 2625 East Fourth Street Long Beach, CA 90814 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)