Health inspection·December 12, 2025

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on interview and record review the facility failed to exercise reasonable care for the protection of the resident's property from loss or theft for one of three sampled residents (Resident 1) when the facility failed to document Resident 1's lost or stolen coin purse containing her social security and identification card were documented in the facility's Theft and Loss log. This failure had the potential to prevent tracking of additional lost items and hinder the facility's ability to identify patterns or trends related to theft and loss of resident property.Findings: During a review of Resident 1's admission Record (AR), the AR indicated the facility originally admitted Resident 1 on 2/3/2020 and readmitted the resident on 2/3/2022 with diagnoses including hypertension (HTN - high blood pressure), osteoarthritis (a progressive disorder of the joints, caused by a gradual loss of cartilage) of the left and right knee, and chronic obstructive pulmonary disease (COPD - a chronic lung disease causing difficulty in breathing).During a review of Resident 1's History and Physical (H&P), dated 4/18/2024, the H&P indicated Resident 1 had the capacity to understand and make decisions.During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool), dated 11/16/2025, the MDS indicated Resident 1's cognitive ability (thought process) was intact. The MDS indicated Resident 1 was independent with activities of daily living (ADLs - activities such as bathing, dressing, and toileting) for eating, toileting, and upper body dressing. The MDS indicated Resident 1 required partial or moderate assistance with the help of staff for lower body dressing and showering.During a review of Resident 1's Care Plan report, dated 12/5/2025, the care plan indicated Resident 1 goes outside of the facility with her family, buys food from outside to share with other residents, and spends her money when she goes out on pass with the family.During an interview with Resident 1 on 12/12/2025 at 12:24 p.m., Resident 1 stated her coin purse with her identification and her social security card were stolen on 12/3/2025 from underneath her pillow where she hides it. Resident 1 stated that she had $600 in her coin purse that she was saving to give to a family member. Resident 1 stated she asked the social worker to file a police report because her Social Security card, identification, and money were in the purse that was taken. Resident 1 stated that the police came, and a report a police report filed on 12/8/2025.During an interview on 12/12/2025 at 1:08 p.m. with Social Service Designee (SSD) 1, SSD 1 stated she was made aware of Resident 1's lost coin purse with the ID and Social Security card inside and stated she arranged for Resident 1 to have her identification and Social Security Card replaced and called the police so a police report could be filed. SSD 1 stated she completed the Resident Grievance/Complaint Investigation Report regarding the lost/missing items and did not complete the Theft and Loss Report or document the lost/missing items on Lost and Stolen Property Log according to the facility Theft and Loss Program Policy. SSD 1 stated it was her mistake she did not complete the Theft and Loss form or document Resident 1's missing items on the Lost and Stolen Log as indicated by the facility policy for Theft and Loss.During an interview on 12/12/2025 at 1:20 p.m. (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: 055932 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 055932 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Four Seasons Healthcare & Wellness Center, LP 5335 Laurel Canyon Blvd. North Hollywood, CA 91607 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)