Health inspection·December 31, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure timely physician notification for a significant change in condition for one of three sampled residents (Resident 1). This deficient practice had the potential to delay physician evaluation, timely medical intervention, and result in the deterioration of Resident 1's condition.Findings: During a review of Resident 1's admission Record, dated 12/19/2025, the admission Record indicated Resident 1 was admitted to the facility on [DATE]. Resident 1's diagnoses included acute and chronic respiratory failure (a condition in which the lungs are unable to provide enough oxygen to the body or remove carbon dioxide, occurring suddenly and/or over a long period of time), chronic obstructive pulmonary disease (COPD- a chronic lung disease causing difficulty in breathing), congestive heart failure (CHF- a heart disorder which causes the heart to not pump blood efficiently, sometimes resulting in leg swelling), acute pulmonary edema (a sudden buildup of fluid in the lungs that makes breathing difficult), pleural effusion (a buildup of fluid between the lungs and the chest wall that can interfere with breathing), type 2 diabetes mellitus (DM- a disorder characterized by difficulty in blood sugar control and poor wound healing), hypertension (HTN- high blood pressure), end stage renal disease (ESRD- a condition in which the kidneys no longer function well enough to remove waste and excess fluid from the body), dependence on renal dialysis (a treatment to cleanse the blood of wastes and extra fluids artificially through a machine when the kidneys have failed), and history of renal transplant (a past medical history of receiving a donor kidney to replace failed kidneys). During a review of Resident 1's Admission/readmission Initial Assessment, dated 8/11/2025 at 7:25 p.m., the admission assessment indicated Resident 1 was readmitted to the facility from the general acute care hospital (GACH). The admission assessment indicated Resident 1 had a normal thought process and was oriented to person, place, and time, was able to follow simple commands, had clear speech, understood verbal content, and was understood upon admission. During a review of Resident 1's History and Physical (H&P), dated 8/12/2025, the H&P indicated Resident 1 had the capacity to understand and make decisions. During a review of Resident 1's Minimum Data Set (MDS- a resident assessment tool), dated 8/15/2025, the MDS indicated Resident 1's cognition (ability to think, remember, and reason) was intact. The MDS indicated Resident 1 could eat independently and required moderate assistance (helper does less than half the effort) for toileting, bathing, and personal hygiene. During a review of Resident 1's care plan titled, Resident at risk for cardiac distress related to A-fib, congestive heart failure, hypercholesterolemia, hypertension, and renal failure/end-stage renal disease, initiated on 8/14/2025, the care plan indicated interventions included to monitor Resident 1 for headache, chest pain, irregular pulse, edema, shortness of breath, elevated blood pressure, dizziness, hypotension (low blood pressure), altered level of mentation and to report findings to the physician promptly. During a review of Resident 1's Nursing Progress Note dated 8/20/2025 at 9:42 p.m., the progress note indicated Resident (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: 056115 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 056115 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/31/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Imperial Healthcare Center 11926 LA Mirada Blvd LA Mirada, CA 90638 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)