Health inspection·May 16, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure one of three sampled residents (Resident 1) bed was placed in a low position, per the resident's Falling Star Program care plan dated 2/13/2024. This failure has resulted in Resident 1, who was assessed as a high risk for falls, being observed in a bed that was not in a lowered position and placed Resident 1 at risk for falling out of bed and injuries. Findings: During a review of Resident 1's admission Record (Face Sheet), the Face Sheet indicated Resident 1 was originally admitted to the facility on [DATE] and readmitted on [DATE] with diagnosis including a diagnosis of generalized weakness. During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool) dated 2/3/2025, the MDS indicated Resident 1 was forgetful and was not able to make reasonable and consistent decisions, he required one to two person assist to complete activities of daily living ([ADLs] routine tasks/activities]) such as transferring from bed/chair to chair. During a review of Resident 1's Care Plan date 2/13/2024, the Care Plan indicated Resident 1 was at risk for falls related to antihypertensive medications (medications used to treat high blood pressure), balance deficit (poor balance), cognitive (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) impairment, decreased strength and endurance, history of falls, poor safety awareness/judgement and an unsteady gait (a person's manner of walking). The Care Plan's goal indicated Resident 1's bed should be in a low position. During an observation of Resident 1 on 5/14/2025 at 3:12 p.m., accompanied by Registered Nurse Supervisor (RNS) 1, and concurrent interview, Resident 1 was observed in bed asleep, lying on his right side close to the edge of the mattress. RNS 1 used a tape measurer to measure the height of Resident 1's bed (from the top of the mattress to the floor), Resident 1's bed was 16 inches high as compared to Resident 1's roommate's (Resident 3) bed, which was almost lowered to the floor. RNS 1 stated Resident 1's bed was not in the lowest position the bed could be placed in, which was 14 inches. During an interview on 5/16/2025 at 4:04 p.m., the Director of Nursing Services (DON) stated during their daily shift huddles interventions and safety precautions are discussed based on residents' care plans and the interventions such as low beds are expected to be implemented to lessen the impact of a fall and injury (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: 056043 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 056043 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Colonial Care Center 1913 E 5th Street Long Beach, CA 90802 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)