Health inspection·April 24, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to investigate and determine how a resident got out of the facility for one of three sampled residents (Resident 1). For Resident 1, who was found in the facility ' s parking lot on 4/13/25, the facility failed to determine how Resident 1 left her room unattended and was found in the facility ' s parking lot. This deficient practice had the potential for Resident 1 to leave the facility unattended again and potentially be exposed to danger. Findings: During a review of the admission Record indicated the facility initially admitted Resident 1 on 2/25/14 and readmitted on [DATE] with diagnoses including schizophrenia (a mental illness that is characterized by disturbances in thought) and anxiety disorder. During a review of Resident 1 ' s Minimum Data Set (MDS, a resident screening tool) dated 1/22/25 indicated Resident 1 had moderately impaired cognitive skills. Resident 1 needed supervision with shower/bathe self, set-up or clean-up assistance with oral hygiene/toileting hygiene, upper/lower body dressing, putting on/taking off footwear, personal hygiene and independent with eating. During a review of Resident 1 ' s Elopement Risk assessment dated [DATE] at 3:43 p.m., indicated Resident 1 had intermittent confusion, ambulatory and was at risk for elopement. During an interview on 4/24/25 at 9:04 a.m., guard 1 stated Resident 1 was found in the parking lot on 4/13/25. Guard 1 stated the facility ' s location is not in a very good neighborhood. Guard 1 stated Resident 1 can be exposed to danger when Resident 1 leaves the facility unattended. During a telephone interview, on 4/24/25 at 10:08 a.m., guard 2 stated he saw Resident 1 standing in the parking lot adjacent to the facility. Guard 2 stated he does not know how Resident 1 got to the parking lot but thinks that Resident 1 may have exited from the window of Resident 1 ' s room. Guard 2 stated he escorted Resident 1 back inside the facility. During a telephone interview on 4/24/25 at 10:30 a.m., licensed vocational nurse (LVN) 1 stated Resident 1 was found in the parking lot on 4/13/25. LVN 1 stated she does not know how long Resident 1 was in the parking lot. LVN 1 stated guard 2 found Resident 1 in the parking lot and escorted Resident 1 back inside the building. LVN 1 stated she did not document because Resident 1 was found in the facility property. LVN1 stated it is important to monitor Resident 1 ' s whereabouts because (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 04/24/2025 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)