F 0558
Reasonably accommodate the needs and preferences of each resident.
Level of Harm - Minimal harm
or potential for actual harm
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review the facility failed to have call device (a mechanism used by
residents to promptly communicate with staff) within reach for three of five sampled residents (Resident 2, 3
and 4). This failure had the potential to result in an accident and/or injury, and/or delay resident care.During
a review Resident 2's admission Record dated 9/29/25 indicated Resident 2 was originally admitted to the
facility on [DATE] with diagnosis including dementia (decline in abilities to remember, make judgments,
think, or make decisions), abnormalities of gait and mobility, chronic obstructive pulmonary disease
(COPD-a chronic lung disease causing difficulty in breathing), major depressive disorder (a mood disorder
that causes a persistent feeling of sadness and loss of interest) and Alzheimer's disease (a disease
characterized by a progressive decline in mental abilities)During a review of Resident 2's Minimum Data
Set (MDS, a resident assessment tool), dated 9/4/25 indicated Resident 2 had mild cognitive (ability to
think, understand and make daily decisions) impairment and required partial/moderate assistance with
most activities of daily living (ADLs, routine tasks/activities such as bathing, dressing and toileting a person
performs daily to care for themselves).During a review of Resident 2's care plan for risk for falls and
associated injury, dated 6/26/25 indicated, an intervention of call light within easy reach and answer
promptly.During a review Resident 3's admission Record dated ---------9/29/25 indicated Resident 3 was
admitted to the facility on [DATE] with diagnosis including Guillian-Barre syndrome (a condition in which the
body's immune system attacks the nerves, causing weakness and numbness that gets progressively
worse), dysphagia (trouble swallowing), candidiasis (fungal infection cause by a yeast-like fungus) and
muscle weakness. During a review of Resident 3's MDS dated [DATE] indicated Resident 3 had mild
cognitive (ability to think, understand and make daily decisions) impairment and required supervision or
touching assistance to dependance on staff for assistance with most ADLs. During a review of Resident 3's
care plan for risk for falls and injuries dated 9/14/25 indicated Maintain call light within reach.During a
review Resident 4's admission Record dated ---------9/29/25 indicated Resident 4 was admitted to the
facility on [DATE] with diagnosis including hypertension (HTN, high blood pressure), major depressive
disorder, Wernicke's encephalopathy (severe, acute brain disorder caused by a deficiency of thiamine
[vitamin B1]), and anxiety disorder (a mental health condition characterized by excessive and persistent
worry, fear, and nervousness that can interfere with daily life). During a review of Resident 4's MDS dated
[DATE] indicated Resident 4 had severe cognitive impairment and required supervision or touching
assistance to partial / moderate assistance by staff for most ADLs.During a review of Resident 4's care plan
for risk for falls dated revised 8/30/25 indicated call light within easy reach and answer promptly.During an
observation with concurrent interview on 9/29/25 at 2:55 pm with Registered Nurse Supervisor ( RNS) 1 in
Resident 2, 3 and 4's room. RNS 1 verified the call light from that room was not illuminating at the call light
panel at the nurses' station which would indicate one of the residents in that room needed
Residents Affected - Few
(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:
055748
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
055748
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
10/03/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Sunset Park Healthcare
2250 29th Street
Santa Monica, CA 90405
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)
F 0558
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
assistance. RNS 1 further verified Resident 3 was given a table bell to use as an alternate way of alerting
the staff she needed help, and Residents 2 and 4 did not have a table bell or alternate way to get the
attention of the staff while their call lights were out of order. RNS 1 stated the risk to the residents would be
the staff would not be aware to address issues on time. During a review of the facility's policy and
procedures Call Light, revised October 2024, indicated, When a resident is in bed or confined to a chair be
sure the call light is within easy reach of the resident.
Event ID:
Facility ID:
055748
If continuation sheet
Page 2 of 2