Health inspection·March 13, 2025

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one of three sampled residents (Resident 1), who was transferred to a General Acute Care Hospital (GACH) due to blood in her urine, was readmitted to the facility, when it was determined by the GACH that Resident 1 was appropriate for transfer back to the facility (2/24/2025). This deficient practice resulted in Resident 1 remaining in the GACH for 20 days after attempts to transfer her back to the facility were made by the GACH. This deficient practice had the potential to cause Resident 1 anxiety and non-continuity of care. Findings: During a review of Resident 1's admission Record (Face Sheet), the Face Sheet indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including alcohol cirrhosis (a severe and irreversible liver disease caused by long-term excessive alcohol consumption) of the liver with ascites (a condition where excessive fluid accumulates in the abdomen) and portal hypertension (a condition in which there is increased blood pressure in the portal vein which is the large vein that carries blood from the digestive organs to the liver). During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool) dated 12/20/2024, the MDS indicated Resident 1's cognition (ability to think and reason) was intact. During a review of Resident 1's Physician's Order dated 2/20/2025, the Physician's Order indicated to transfer Resident 1 to a GACH due to blood in her urine. During a review of Resident 1's SBAR note ([situation, background, assessment, recommendation] a communication tool used by healthcare workers when there is a change of condition among the residents) dated 2/20/2025 and timed at 8:42 p.m., the SBAR note indicated Resident 1 was discharged via ambulance to the GACH. During a review of Resident 1's Bed Hold Notice dated 6/18/2025, the Bed Hold Notice indicated Resident 1 had the option of requesting within 24 hours a seven (7) day bed hold to keep a bed vacant and available for return to the facility. During a review of the Facility Census dated 2/24/2025, the Facility Census indicated Resident 1's room was available. (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: 055995 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 055995 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE North Long Beach Post Acute 260 E Market St Long Beach, CA 90805 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)