Health inspection·December 20, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility P&P review, the facility failed to provide the necessary care and services to ensure one of four sampled residents (Resident 4) attained and maintained their highest practicable well-being. Residents Affected - Some * The facility failed to monitor Resident 4 after the resident had an unwitnessed fall. This failure had the potential for delay and not providing the necessary care and services if the resident had a change in condition. Findings: Review of the facility's P&P titled Change in a Resident's Condition or Status revised January 2012 showed the nurse supervisor/charge nurse will record in the resident's medical record information relative to changes in the resident's medical/mental condition status. The assessment related to the change in condition will be documented for 72 hours unless the condition requires continued documentation or the physician's orders otherwise. Medical record review for Resident 4 was initiated on 12/18/24. Resident 4 was admitted to the facility on [DATE]. Review of Resident 4's H&P examination dated 9/18/24, showed Resident 4 had the capacity to understand and make decisions. Review of Resident 4's SBAR Communication Form dated 12/13/24, showed Resident 4 was found on the floor by the CNA. Review of Resident 4's Plan of Care showed a care plan problem revised 12/17/24, addressingResident 4's fall incident on 12/13/24. The interventions/tasks included to monitor/ document/report PRN for 72 hours to MD for signs and symptoms of pain, bruises, change in mental status, and new onset of confusion, sleepiness, inability to maintain posture, agitation. Review of Resident 4's Progress Notes dated 12/14 - 12/17/24, failed to show documented evidence of continued monitoring of Resident 4 for any negative impact from the fall incident on 12/13/24. On 12/18/24 at 1520 hours, an interview and concurrent medical record review was conducted with the ADON. The ADON stated the fall incident was considered a change of condition. The ADON stated for any change of condition, the resident would be assessed and monitored every shift for 72 hours. The ADON verified the Resident 4 was not monitored continuously for negative impact from the fall (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: 055984 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 055984 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anaheim Healthcare Center, LLC 501 South Beach Blvd. Anaheim, CA 92804 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)