Health inspection·October 29, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility P&P review, the facility failed to develop a care plan for two of three sampled residents (Residents 1 and 2). * The facility failed to develop a care plan for Resident 1's sexual and physical abuse allegations. * The facility failed to develop a care plan for Resident 2 allegedly hitting another resident. These failures had the potential to negatively impact the residents care. Findings: Review of facility's P&P titled Care Plan Comprehensive effective 8/25/21, showed an individualized comprehensive care plan includes measurable objectives and timetables to meet the resident's medical, physical, mental and psychosocial needs shall be developed for each resident. The facility's IDT, in coordination with the resident and/or his/her family or representative, must develop and implement a comprehensive person-centered care plan for each resident, that includes measurable objectives and timeframes to meet a resident's medical, physical, and mental and psychosocial needs that are identified in the comprehensive assessment. The resident's comprehensive care plan is developed within seven (7) days of the completion of the resident's comprehensive assessment. Assessments of residents are ongoing, and care plans are reviewed and revised as information about the resident and the resident 's condition change. On 10/27/25, the CDPH L&C Program received a report from the facility alleging Resident 2 hit Resident 1 on the right arm and was sexually inappropriate with him on 10/25/25. 1. Medical record review for Resident 2 was initiated on 10/29/25. Resident 2 was initially admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 2's H&P examination dated 6/30/23, showed the resident had diagnoses including a history of exposing self, responding to internal stimuli, disorganized, poor boundaries, poor impulse control, delusional, paranoia, and schizophrenia. Review of Resident 2's medical record failed to show documented evidence a care plan was developed for the incident of Resident 2 allegedly hitting another resident on the right arm. On 10/29/25 at 1335 hours, an interview, and concurrent medical record review for Resident 2 was conducted with the DON. The DON reviewed Resident 2's care plans and verified there was no care plan developed for Resident 2 allegedly hitting another resident. 2. Medical record review for Resident 1 was initiated on 10/28/25. Resident 1 was readmitted to the facility on [DATE]. (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: 055653 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 055653 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/29/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE South Coast Post Acute 1030 W Warner Ave Santa Ana, CA 92707 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)