Health inspection·January 9, 2026

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few aspirate daily and as neededDated [DATE], [DATE] - Left ischium wound cleanse with NS, pat dry, then apply collagen powder, followed by border foam to secure dailyDated [DATE], [DATE] - Suprapubic catheter care daily cleanse urinary insertion site with NS and pat dry and cover with dry dressing daily and prnDuring a review of Resident 1's TAR, the TAR indicated the following treatment order was signed and documented as given:Dated [DATE], flush suprapubic with 30 cc of normal saline, slow push, do not aspirate daily and as needed.During an interview with Resident 1 on [DATE] at 12:22 p.m., Resident 1 stated, on [DATE], he did not receive any skin treatment that was supposed to be given daily because there was no treatment nurse available for that day. Resident 1 further stated, he has a suprapubic catheter that needed daily care.During a concurrent interview and record review with Treatment Nurse 1 (TXN 1) on [DATE] at 12:46 p.m., TXN 1 stated, she did not do any skin treatment done to Resident 1 on [DATE] because he refused to get his suprapubic catheter daily care. TXN 1 stated, she documented and signed on the physician's order for daily flush of suprapubic catheter with normal saline, but Resident 1 is the one who does it himself. TXN 1 stated, Resident 1 would always tell her that he does it himself, but she had not seen him doing it himself. TXN 1 further stated, she documented that she administered and did the treatment care on [DATE] and for the rest of [DATE] and [DATE] for Resident 1 but she did not do it herself. TXN 1 further stated, if she assumed that resident did the treatment himself without doing her own assessment and evaluation that Resident 1 may safely do the treatment himself then this could cause injury to Resident 1 such as obstruction, inflammation and damage to Resident 1's internal organs.During an interview with Registered Nurse 1 (RN 1) on [DATE] at 1:22 p.m., RN 1 stated, residents who are allowed to do self-medication and self-treatment done should be evaluated by the licensed nurses prior to ensure that they can do the treatment by themselves. RN 1 stated, they have to make sure that the supply that resident uses are the correct supply and the medications were not expired. RN 1 stated, if residents do their own treatment without being assessed and evaluated, they are at risk of infection because they might not be doing the treatment correctly.During a review of the admission Record indicated Resident 2 was originally admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including neuromuscular dysfunction of bladder (refers to bladder control problems caused by damage to the nerves, spinal cord, or brain), hypertension (HTN-high blood pressure) and atrial fibrillation (afib- an irregular and very rapid heart rhythm that and can lead blood clots in the heart).During a review of the Minimum Data Set (MDS - resident assessment tool) dated [DATE], indicated Resident 1's cognitive (mental action or process of acquiring knowledge and understanding) skills for daily decisions was intact. The MDS indicated Resident 1 required moderate to maximal assistance from staff for activities of daily living (ADLs- routine tasks/activities such as bathing, dressing and toileting a person performs daily to care for themselves). The MDS also indicated, Resident 1 has an indwelling catheter (a thin, flexible tube left inside the bladder to drain urine into a bag, using a small, inflated balloon to hold it in place).During a review of Resident 2's OSR, dated [DATE], the OSR indicated the following physician's order:For sacrococcyx (refers to the connected bones at the very bottom of spine) open wound: cleanse with NS, pat dry, apply medihoney (a special, medical-grade honey used for wounds and burns) cover with dry dressing every dayKetoconazole external cream (a powerful antifungal medication used to treat infections caused by fungus or yeast) two percent (% - unit of measurement) - apply to right lower back topically one time a dayDuring a review of Resident 2's TAR for [DATE], the TAR indicated the following treatment orders were blank and did not have any documentation why the TAR was blank and/or if resident refused the treatment:Dated [DATE], [DATE], [DATE] - For sacrococcyx open wound: cleanse with NS, pat dry, apply cover with dry dressing every dayDated [DATE], [DATE] (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055473 If continuation sheet Page 2 of 3 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 055473 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/09/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Vista Post-Acute Care Center 1516 Sawtelle Blvd. Los Angeles, CA 90025 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)

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Ketoconazole external cream two percent - apply to right lower back topically one time a dayDuring an interview with RN 1 on [DATE] at 1:07 p.m., RN 1 stated, if TAR is blank and no documentation why the log was blank, it means, the treatment was not done, and the correct process is to document why the treatment was not done and do not leave the TAR log blank. RN 1 stated, if treatments were not done, this can affect resident's wound healing, it may get worse.During a review of the facility's policy and procedures (P&P) titled, Medication - Self Administration, reviewed on [DATE], the P&P indicated that, It is the responsibility of the IDT to determine if it is safe for the resident to self-administer drugs before the resident may exercise that right. The IDT must determine whether the resident or the nursing staff will be responsible for storage and documentation of the administration of the medications, as well as, the location where the medications will be administered. These determinations should appear on the resident's comprehensive plan of care.During a review of the facility's P&P titled, Prevention of Pressure Ulcers/Injuries, reviewed on [DATE], the P&P indicated that, The following information should be documented in the resident's clinical record: The type of skin care rendered, the date and time skin care was given, the name and title of the individual who gave the care; any change in the resident's condition; the condition of the resident's skin; how the resident tolerated the procedure or his/her ability to participate in the procedure; any problems or complains made by the resident related to the procedure, if the resident refused the care, the reason (s) why; observation of anything unusual exhibited by the resident; the signature and title of the person recording the data; documentation of advance directives. Event ID: Facility ID: 055473 If continuation sheet Page 3 of 3