Health inspection·July 31, 2025

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the nutritional supplement ordered by the physician for one of three sampled residents' (Resident 1), were monitored and documented.This failure had the potential to result in delayed identification of low or poor intake and interventions, causing further weight loss.Findings: During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted on [DATE]. The admission Record indicated Resident 1 had a history of malignant neoplasm (cancer) of the lung, dementia (a progressive state of decline in mental abilities), stage 4 pressure ulcer (Full-thickness skin and tissue loss with exposed muscle, tendon, ligament, cartilage, or bone) of the sacral region (lower back), and unstageable pressure ulcers (localized, pressure-related damage to the skin and/or underlying tissue usually over a bony prominence that cannot be fully evaluated due to layers of dead tissue) of the left buttock, right heel, and left heel. The admission Record indicated Resident 1 was discharged on 7/15/2025.During a review of Resident 1's History and Physical (H&P), dated 6/27/2025, the H&P indicated Resident 1 was alert and aware of his name only. The H&P indicated Resident 1 weighed 124 pounds (lbs, a unit of mass).During a review of Resident 1's Minimum Data Set (MDS - a federally mandated resident assessment tool), dated 7/15/2025, the MDS indicated Resident 1 was dependent (helper does all the effort) on staff to eat (the ability to bring food and/or liquid to the mouth and swallow), perform oral hygiene, and roll left and right.During a review of Resident 1's Medication Administration Record (MAR - a daily documentation record used by a licensed nurse to document medications and treatments given to a resident), for 7/2025, the MAR did not indicate the intake of health shake in percentage from 7/3/2025-7/10/2025 and from 7/10/2025-7/14/2025 three times per dayDuring a review of Resident 1's Documentation Survey Reports, dated 7/2025, the Documentation Survey Reports section NUTRITION- Amount Eaten were blank on 7/3/2025, 7/8/2025, and 7/20/2025 at 7:00 a.m. and 12:00 p.m. The Documentation Survey Reports sections NUTRITION - Nourishment 10 a.m. and NUTRITION - 2 p.m. were blank from 7/1/2025-7/8/2025 and 7/9/2025-7/13/2025.During a review of Resident 1's Care Plan titled Risk for Impaired Skin Integrity, dated 7/2/2025, the care plan indicated staff will monitor Resident 1's nutritional intake.During a review of Resident 1's Care Plan titled The resident has dehydration or potential for fluid deficit r/t disease process, hx (history) of uti (urinary tract infection- an infection in the bladder/urinary tract), retention of urine, dated 7/2/2025, the care plan indicated staff will monitor and document Resident 1's intake and output as per facility policy.During a concurrent interview and record review on 7/31/2025 at 11:30 a.m. with Licensed Vocational Nurse (LVN 1), Resident 1's MAR for 7/2025 was reviewed. LVN 1 stated Resident 1's history of dementia and cancer increased his risk of malnutrition (an imbalance of nutrients, leading to health problems). LVN 1 stated nursing staff are responsible for monitoring Resident 1's oral intake but did not. LVN 1 stated the MAR indicated Resident 1 received health shakes and snacks as ordered, but did not indicate Resident 1's consumption of the health Residents Affected - Few Page 1 of 2 055737 055737 07/31/2025 Sunny Hills Post Acute 12200 LA Mirada Blvd. LA Mirada, CA 90638

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few shakes and snacks.During a concurrent interview and record review on 7/31/2025 at 12:42 p.m. with Certified Nursing Assistant 1 (CNA 1), Resident 1's Documentation Survey Reports dated 7/2025 was reviewed. CNA 1 stated Resident 1 did not drink more than 25% of his prescribed health shakes and snacks. CNA 1 stated staff were supposed to document the intake of all food and liquid but did not document Resident 1's health shakes and snacks. CNA 1 stated the Documentation Survey Report indicated CNAs did not monitor and document Resident 1's meal intake for breakfast and lunch on 7/3/2025, 7/8/2025, and 7/10/2025. CNA 1 stated the Documentation Survey Report indicated Resident 1's health shake and snack consumption was not monitored and documented from 7/1/2025-7/8/2025 and 7/10/2025-7/14/2025.During a concurrent interview and record review on 7/31/2025 at 1:50 p.m. with Registered Nurse (RN 1), Resident 1's Care Plan titled Risk for Impaired Skin Integrity dated 7/2/2025, Resident 1's Documentation Survey Reports for 7/2025, Resident 1's MAR for 7/2025 were reviewed. RN 1 stated the care plan and P&P indicated Resident 1's intake of meals, snacks, and health shakes should have been monitored and documented. RN 1 stated the Documentation Survey Reports and MAR indicated snack and health shake consumption was not monitored or documented. RN 1 stated the MAR indicated the snack and shakes were offered but there was no indication of how much Resident 1 consumed. RN 1 stated Resident 1's meal consumption was not monitored or documented for breakfast and lunch on 7/3/2025, 7/8/2025, and 7/10/2025. RN 1 stated the missing meal, snack, and health shake intake monitoring increased Resident 1's risk of weight loss, delayed wound healing, and hospitalization.During a concurrent interview and record review on 7/31/2025 at 2:24 p.m. with LVN 2, Resident 1's Care Plan titled The resident has dehydration or potential for fluid deficit r/t disease process, hx of uti, retention of urine, dated 7/2/2025, and the facility's P&P titled Weight Monitoring, dated 12/19/2022, were reviewed. LVN 2 stated Resident 1's Care Plan indicated staff should have monitored and documented intake and output according to facility policy. LVN 2 stated the P&P was not followed when Resident 1's nutritional interventions of snacks and health shakes was not monitored according to current professional standards.During an interview on 7/31/2025 at 4:20 p.m. with the Director of Nursing (DON), the DON stated nursing staff must monitor residents' consumption of nutrition interventions such as supplements and snacks to guide and individualize the plan of care. The DON stated Resident 1's consumption of snacks and health shakes was not monitored or documented anywhere in his chart.During a review of the facility's Certified Nursing Assistant (CNA) Job Description, dated 2003, the CNA job description indicated CNA's duties include recording residents' food/fluid intake and report changes in the resident's eating habits.During a review of the facility's P&P titled Weight Monitoring, dated 12/19/2022, the P&P indicated the facility will utilize a systemic approach to optimize a resident's nutritional status. The P&P indicated resident care plans should identify resident/specific interventions that will be identified, implemented, monitored, and modified consistent with resident goals and current professional standards. 055737 Page 2 of 2