Health inspection·February 27, 2025

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to readmit one of three sampled residents (Resident 1) on 2/13/2025 to the facility after hospitalization to a General Acute Care Hospital (GACH), as indicated in the facility's policy titled Readmission. As a result, Resident 1 remained in the GACH with discharge orders written on 2/12/2025 to return to the facility. Denying the resident the right to return to their home in the facility and placing Resident 1 at risk for psychosocial harm. Findings: During a review of Resident 1's admission Records dated 2/26/2025, the resident was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including quadriplegia (paralysis below the neck that affects all a person's limbs), type two diabetes (A long-term condition in which the body has trouble controlling blood sugar and using it for energy). During a review of Resident 1 ' s Minimum Data Set (MDS- a resident assessment tool), dated 12/11/2024 the MDS indicted Resident 1 had intact cognitive skills (mental action or process of acquiring knowledge and understanding) to make daily decisions on self-care activities. The MDS indicated the resident was dependent on staff for position changes such as sitting to lying, lying to sitting on side of bed, sit to stand, chair/bed-to-chair transfer. During a review of Resident 1 ' s History and physical (H&P) dated 6/6/2024, the H&P indicated Resident 1 had a cervical 3 to cervical 5 spinal injury, functional quadriplegic (paralysis below the neck that affects all a person's limbs), type two diabetes (A long-term condition in which the body has trouble controlling blood sugar and using it for energy). The H&P indicated resident has the capacity to understand and make decisions. During a review of Resident 1 ' s General Acute Care Hospital (GACH) Patient Orders dated 2/12/2025 indicated, Resident 1 was to be discharged from GACH back to the Skilled Nursing Facility (SNF) on 2/12/2025. During a revie of Resident 1 ' s GACH Patient Orders dated 2/12/2025 indicated, Discharge to NF (Nursing Facility) today, continue IV (Intravenous) Vancomycin (an antibiotics medication used to treat and prevent various bacterial infections) 1250 milligram IVPB (Intravenous Piggy Bag) daily times 2 more weeks, and Ceftriaxone (an antibiotics medication used to treat bacterial infections in many different parts of the body) 2 milligram IVPB daily times one more week. (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: 055704 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 055704 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Angels Nursing Health Center 415 S Union Avenue Los Angeles, CA 90017 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)