Health inspection·August 19, 2025

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the residents' choices or preferences were honored for one (1) of three (3) sampled residents (Resident 1) in accordance with the facility's policy and procedure. This deficient practice had the potential to negatively affect Resident 1's self-worth, self-esteem, and psychosocial well-being. Findings:During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted to the facility on [DATE] and re- admitted on [DATE] with diagnoses included cerebral infarction (refers to damage to tissues in the brain due to a loss of oxygen to the area) affecting left dominant side, anxiety disorder (a disorder characterized by nervousness characterized by a state of excessive uneasiness and apprehension, typically with compulsive behavior [repetitive, persistent, and often uncontrollable actions that a person feels driven to perform] or panic attacks), and panic disorder (sudden, intense feelings of fear that cause physical symptoms like a racing heart, fast breathing and sweating) During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool), the MDS dated [DATE], indicated Resident 1 has intact cognitive (mental action or process of acquiring knowledge and understanding) skills for daily decision making. The MDS indicated Resident 1 needed partial/ moderate assistance (helper does less than half the effort, helper lifts, holds, or supports trunk or limbs but provides less than half the effort) in oral hygiene, toileting hygiene, shower/bathe self, upper and lower body dressing, putting on and taking off footwear, personal hygiene, roll left and right, sit to lying, lying to sitting on side of the bed, sit to stand, chair / bed- to-chair transfer, toilet transfer, tub/ shower transfer and walk 10 feet. During a record review of a facility form titled, Concern Record (Theft/ Loss and Grievance Report), dated 3/14/2025, the Concern Record indicated Resident 1 would like to improve the quality of care as follows: Ensure pitcher and call light were placed in reach. Please inform the Resident what procedures your about to do prior to engaging. When staff are feeding a Resident, their co-workers should not come inside the room and have conversations. Staff should limit perfume use. Introduce the floater prior going to lunch During a concurrent interview and record review on 8/19/2025 at 1:40 PM with Social Services Director (SSD), Resident 1's Concern Record, dated 3/14/2025, was reviewed. SSD stated when Resident has concerns, the licensed nurses, social service director (SSD) or the Director of Nursing (DON) completes the concern record form. The Concern Record form will be submitted to the Social Services Department then filed in the Grievance Binder. SSD stated the SSD will do the follow-up interview with the Resident and the DON and Administrator will investigate. SSD also stated, if the staff were not able to follow the resident's preferences, it could lead to unmet needs and resident could get frustrated. During a concurrent interview and record review on 8/19/2025 at 1:58 PM with Resident 1, Resident 1's Concern Record, dated 3/14/2025 was reviewed. Resident 1 stated, I need to remind my CNA (Certified Nursing Assistant) to put my call light on my right-hand side. I cannot move my left arm. Resident 1 stated, The call light usually gets misplaced or falls on the floor and I 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 2 Event ID: 056127 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 056127 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Live Oak Rehab Center 537 W Live Oak San Gabriel, CA 91776 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)