Health inspection·September 25, 2024

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Allow resident to participate in the development and implementation of his or her person-centered plan of care. Based on record review and interview, the facility failed to ensure resident ' s representative (RR) was invited and included in the formulation of a person-centered baseline care plan (CP -implementation of care plan goals and interventions) that was to be done within 48 hours of resident ' s admission when the facility discussed the initial plan of care to one of two cognitively impaired (problems with ability to think, learn and remember) sampled residents (Resident 1). This failure resulted in RR being uninformed and was not given at the opportunity to participate in making decisions for Resident 1 ' s initial plan of care, treatment, and healthcare goals that could affect Resident 1 ' s care and quality of life. Findings: During a review of the facility ' s policy and procedure (P&P), titled, Care Planning, dated 10/2023, the P&P indicated, in part, I. The facility will develop a person-centered Baseline Care Plan for each resident within 48 hours of admission .A. The facility will invite the resident, if capable, and their family to the care planning meetings and use its best effort to schedule care planning meetings at times convenient for the resident and family .B. IDT meetings may be conducted via teleconference. During a review of Resident 1 ' s admission packet (AP), titled, Health & Safety Code 1599, undated, the AP indicated, Written policies regarding the rights of patients shall be established and shall be available to patient, to any guardian, next of kin, sponsoring agency or representative payee, and to the public.in part .Any rights under this chapter of a patient judicially determined to be incompetent, or who is found by his physician to be medically incapable of understanding such information, or who exhibits a communication barrier, shall devolve to such patient ' s guardian, conservator, next of kin, sponsoring agency or representative payer, except when the facility itself is the representative of the payer. During a review of Resident 1 ' s Nursing admission Assessment (NAA),dated 8/2/24, the NAA neurological assessment (assessing mental status and level of consciousness) indicated, Resident 1 was alert, oriented to person, had difficulty in new situations. Further review of NAA, dehydration screening functional signs indicated, that Resident 1 had cognitive impairment. During a review of Resident 1 ' s History and Physical (H&P),dated 8/3/24, the H&P indicated, Resident 1 can make needs known but cannot make medical decisions. During a review of Resident 1 ' s MDS section C for mental status, dated 8/5/24, Resident 1 ' s had (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 3 Event ID: 055991 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 055991 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/25/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mission Park Healthcare Center 623 West Junipero Street Santa Barbara, CA 93105 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)