Health inspection·February 1, 2024

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to update and document belongings brought by the family on the inventory list for three of four sampled residents (Resident 1, 4, 5). This failure resulted in residents losing items due to not having them written down on the inventory list. Findings: a. During a record review of Resident 1 Face Sheet (admission record), the Face Sheet indicated Resident 1 was initially admitted on [DATE] and was readmitted on [DATE] with diagnosis including hypertensive heart (chronic blood pressure elevation) and chronic kidney disease (CKD: gradual loss of the kidney function), history of falling, and dementia (impaired ability to think, make decisions) with other behavioral disturbance (verbal and physical aggression, wandering). During a record review of Resident 1 ' s Minimum Data Set [(MDS) a standardized assessment and care screening tool], dated 1/10/2024, the MDS indicated Resident 1 ' s cognitive skills (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) were severely impaired. The MDS indicated Resident 1 is dependent on bathing and transferring from chair/bed to chair transfer and required substantial/maximal assistance in performing activities of daily living (ADL: hygiene, dressing, eating) and utilizes a wheelchair. During a record review of Resident 1 ' s Inventory List (list of resident ' s belongings), it indicated Resident 1 was missing a green Christmas sweater, blue adidas suit, two radios, black and yellow pants outfit, black and white dress with hood, and a blue sweatshirt. During a record review of Resident 1 ' s Theft/Loss Report (document that indicates missing item information), Resident 1 ' s green sweater was seen on another resident and other items that have not been seen for month. During an interview on 2/13/2024 at 11:22am with Resident 1 ' s daughter, the daughter indicated Resident 1 has been missing some of her clothing ' s and stated she does Resident 1 ' s laundry at home to prevent items going missing at the facility and is not sure why the items are missing as she writes Resident 1 ' s name on the inside and outside of Resident 1 ' s clothes. The daughter indicated she has seen some of the residents wearing her Resident 1 ' s clothes. The daughter stated when she brings in new clothes, she notifies the staff to have the item listed on the inventory list. The daughter stated she does Resident 1 ' s laundry every two days and brings back whatever was washed. (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 3 Event ID: 055531 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 055531 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/01/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beachside Post Acute 22520 Maple Avenue Torrance, CA 90505 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)