Health inspection·August 5, 2025

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to permit one of three sampled residents (Resident 1) to return to the facility after Resident 1 was transferred to General Acute Care Hospital 1 (GACH 1) for psychiatric (the branch of medicine focused on the diagnosis, treatment, and prevention of mental, emotional, and behavioral disorders) evaluation. This deficient practice subjected Resident 1 to an unnecessary prolonged hospitalization, violated Resident 1's rights to return to their facility, and has the potential to result in Resident 1's displacement in an unfamiliar facility requiring adjusting to new surroundings.During a review of Resident 1's admission Record, the admission Record indicated the facility originally admitted the resident on 4/12/2025 with diagnoses that included difficulty walking, alcohol abuse (a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol or continuing to use alcohol even when it causes problems), alcohol dependence (condition where a person experiences a strong compulsion to drink alcohol and is unable to control their drinking despite negative consequences) with withdrawal (symptoms that may occur when a person who has been drinking too much alcohol on a regular basis suddenly stops drinking alcohol), unspecified psychosis (severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality) not due to substance or known physiological condition, anxiety disorder (intense, excessive, and persistent worry and fear about everyday situations), poisoning by fentanyl (used to treat severe pain) or fentanyl analogs, accidental (unintentional), unsheltered homelessness. During a review of Resident 1's Minimum Data Set (MDS -a resident assessment tool) dated 6/5/2024, the MDS indicated that Resident 1 was cognitively (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) impaired and was dependent from staff for transfer, dressing, toilet use, personal hygiene, and bathing.During a review of Resident 1's physician order, the physician order indicated an order to transfer via 5150 (a 72-hour hold [temporary detention] for mental health evaluation) to GACH 1, dated 7/31/2025 timed 1:42 p.m.During a review of Resident 1's Situation, Background, Assessment, Recommendation (SBAR- a sudden clinically important deviation from a resident's baseline in physical, cognitive, behavioral, or functional domains) Communication Form dated 7/31/2025, the SBAR indicated Resident 1 was physically aggressive towards staff. Danger to others evidenced by physical assault to staff.During a review of Resident 1's Nurses Notes dated 7/31/2025 timed 1:42 p.m., the Nurses Notes indicated Resident 1 placed on hold for danger to others escorted by law enforcement to GACH 1 psychiatric unit.During a review of Resident 1's GACH 1 Emergency Documentation note dated 7/31/2025 timed 6:27 p.m., the Emergency Documentation note indicated that psychiatry (psych- a branch of medicine focused on the diagnosis, treatment, and prevention of mental, emotional, and behavioral disorders) is not accepting hold. During a review of Resident 1's GACH 1 Emergency Documentation note dated 7/31/2025 timed 8:48 p.m., facility will not be taking resident, resident cannot be (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: 056031 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 056031 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/05/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunland Post Acute 8647 Fenwick Street. Sunland, CA 91040 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)