Health inspection·September 19, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the licensed nursing staff failed to remove a pressure dressing (a type of bandage applied to a hemodialysis access site after hemodialysis treatment [a medical procedure that removes waste products and excess fluid from the blood when the kidneys are unable to do so] to stop bleeding) for one of three sampled residents (Resident 1) and failed to document the condition of the hemodialysis access site dressing and any part of report from the hemodialysis nurse post-hemodialysis, every shift, for three of three sampled residents (Residents 1, 2, and 3).These deficient practices placed Resident 1 at risk for impaired circulation (disruption of the movement of blood through the body, preventing delivery of oxygen and nutrients to tissues) and infection to the hemodialysis access site. These deficient practices also placed Residents 1, 2, and 3 at risk of sustaining complications related to hemodialysis due to undocumented assessments of their dialysis access sites and required care instructions.Findings: 1. During a review of Resident 1's admission Record, the admission Record indicated the facility admitted Resident 1 on 6/23/2025. Resident 1's diagnoses included end stage renal disease (ESRD, a persistent decline in kidney function requiring long-term dialysis). During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool), dated 6/24/2025, the MDS indicated Resident 1 had severely impaired cognition (a significant decline in a person's mental abilities). The MDS indicated Resident 1 was dependent on facility staff for all activities of daily living (activities such as bathing, dressing and toileting a person performs daily) and mobility while in and out of bed. During a review of Resident 1's physician orders, dated 8/29/2025, the order indicated staff were to monitor Resident 1's hemodialysis access site every shift for bruit (a whooshing orblowing sound heard through a stethoscope when listening to blood vessels in the body) and thrill (a palpable, humming vibration felt on the skin). During a review of Resident 1's Dialysis Communication Record, dated 9/12/2025, the record indicated facility staff were to remove Resident 1's pressure dressing on 9/12/2025 after 12:00 PM. The record indicated the instructions were received by Licensed Vocational Nurse (LVN) 1. During an interview on 9/18/2025 at 2:45 PM, with LVN 1, LVN 1 stated she was responsible for Resident 1's nursing care on 9/12/2025 from 7:00 AM to 3:00 PM. LVN 1 stated she could not recall why Resident 1's dressing was not removed as ordered and stated she likely forgot about the instruction to remove it. LVN 1 stated the purpose of removing the pressure dressing was to prevent infection and to ensure that circulation was maintained. During a review of Resident 1's Dialysis Communication Record, dated 9/17/2025, the record indicated facility staff were to remove Resident 1's pressure dressing on 9/17/2025 after 12:00 PM. The record indicated the instructions were received by LVN 2. During an observation on 9/18/2025 at 11:00 AM, Resident 1 was observed with swelling to her right arm. During a concurrent observation and interview, on 9/18/2025 at 11:08 AM, with LVN 2, Resident 2's right arm and hemodialysis access site were observed. LVN 2 stated Resident 1's arm was swollen in comparison to her left arm. LVN 2 stated Resident 1's Residents Affected - Few (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: 056023 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 056023 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Avalon Villa Care Center 12029 Avalon Blvd Los Angeles, CA 90061 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)