F 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room,
etc.) that affect the resident.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review, the facility failed to ensure one of three sampled residents
(Resident 1) physician and power of attorney ([POA] decision maker) was notified of refusals of Ciclopirox
cream (antifungal cream) treatment to both feet BID for tinea pedis (fungal infection) on 1/8/2026,
1/10/2026, 1/11/2026 and 1/12/2026.This failure resulted in Resident 1 not receiving treatment and care for
four days and had the potential to cause infection, inflammation and hospitalization.Findings:During a
review of Resident 1's admission Record dated 1/21/2026, the admission record indicated Resident 1 was
admitted to the facility on [DATE] and re-admitted on [DATE] with diagnosis including diabetes mellitus (a
condition in which the body fails to process glucose (sugar)), and rheumatoid arthritis (a chronic
progressive disease-causing inflammation in the joints and resulting in painful deformity and
immobility).During a review of Resident 1's History and Physical (H&P) dated 12/17/2026, the H&P
indicated Resident 1 was alert and oriented.During a review of Resident 1's Minimum Data Set ([MDS] - a
standardized assessment and care screening tool) dated 11/7/2026, the MDS indicated Resident 1 had
moderate cognitive impairment (a decline in cognitive functions like memory, language, thinking). The MDS
indicated Resident 1 needed substantial/ maximal assist (helper does more than half the work) with
activities of daily living ([ADL] such as toileting, dressing and bathing). The MDS indicated Resident 1 had
an infection on both feet.During a review of Resident 1's physician order dated 11/6/2025, the physician
order indicated to administer Ciclopirox cream to both feet once a day for Tinea Pedis.During a review of
Resident 1's Progress Note dated 1/8/2026 at 9:56 a.m., the progress note indicated Resident 1 had
refused treatment on both of her feet.During a review of Resident 1's Progress Note dated 1/10/2026 at
10:24 a.m., the progress noted indicated Resident 1 had refused treatment on both of her feet.During a
review of Resident 1's Progress Note dated 1/11/2026 at 11:40 a.m., the progress noted indicated Resident
1 had refused treatment on both of her feet.During a review of Resident 1's Progress Note dated 1/12/2026
at 1:08 p.m., the progress noted indicated Resident 1 had refused treatment on both of her feet.During a
review of Resident 1's Treatment Administration Record (TAR) dated 1/21/2026, the TAR indicated Resident
1 had refused her feet fungal treatments of ciclopirox cream to both feet on 1/10/26, 1/11/2026, and
1/12/2026.During a phone interview on 1/21/2026 at 11:04 am with Treatment Nurse (TXN) 2, TXN 2 stated
he should have notified the physician and the POA after Resident 1's third fungal treatment refusal to both
of her feet on the following days: 1/8/26, 1/10/26, 1/11/2026 and 1/12/2026.During a concurrent interview
and record review on 1/21/2026 at 3:00 pm with the Director of Nurses (DON), Resident 1's Tx refusal
documentation and GACH ER summary visit report were reviewed. The DON stated TXN 2 should have
done a COC when Resident 1 refused her feet fungal treatment for the third time, so the nurses could have
let the physician know and possibly see about a new plan of care. The DON stated that TXN 2 should have
notified Resident 1's POA that Resident 1 refused treatment on her
(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:
055894
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
055894
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/21/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Broadway by the Sea
2725 E. Broadway
Long Beach, CA 90803
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 0580
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
feet so the POA could have talked to Resident 1 about her refusing care.During a review of the facility's
policy and procedure (P&P) titled Change of Condition dated 4/2025, the P&P indicated it is the policy of
this facility to ensure each resident receives quality of care and services to attain and maintain the highest
practicable physical mental and psychosocial well-being in accordance with the interdisciplinary
comprehensive assessment and plan of care. The P&P indicated if at any time, it is recognized by any one
of the team members that the condition or care needs of the resident have changed, the Licensed Nurse or
Nurse Supervisor should be made aware. The P&P indicated nurse shall use his/ her clinical judgment and
contact the physician. The P&P indicated the resident/ resident representative will be notified of the change
of condition and any changes in the resident's medical or nursing care.
Event ID:
Facility ID:
055894
If continuation sheet
Page 2 of 2