Health inspection·December 10, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure one of 3 sampled residents ' (Resident 1) personal wheelchair was accounted for, in the resident ' s inventory list (a document where a resident ' s personal belongings are listed/ added when received), as indicated in the facility ' s policy and procedure (P&P) titled, Inventory List, Resident ' s Personal. This failure had the potential to result in Resident 1 ' s wheelchair lost or stolen. Findings: During a review of Resident 1 ' s admission Record, the admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnosis including hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body) following cerebral infarction (stroke, loss of blood flow to a part of the brain). During a review of Resident 1 ' s History and Physical (H&P), dated 9/26/2024, the H&P indicated Resident 1 had the capacity to understand and make decisions. During a concurrent observation and interview on 12/10/2024 at 9:12 a.m. with Licensed Vocational Nurse (LVN 1) in the Rehabilitation Room, Resident 1 ' s identifying information was observed on an orange tag on Resident 1 ' s wheelchair. LVN 1 stated the tag was present on the wheelchair to identify Resident 1 is the wheelchair ' s owner. During an interview on 12/10/2024 at 9:16 a.m., the Assistant Director of Rehabilitation (ADOR) stated, Resident 1 ' s wheelchair was Resident 1 ' s personal property and did not belong to the facility. During a concurrent interview and record review on 12/10/2024 at 9:19 a.m. with LVN 1, Resident 1 ' s undated Inventory List was reviewed. The Inventory List did not indicate Resident 1 had a personal wheelchair. LVN 1 stated nursing or rehabilitation department staff should have updated Resident 1 ' s Inventory List to include Resident 1's wheelchair. During a concurrent interview and record review on 12/10/2024 at 9:59 a.m. with LVN 2, the facility ' s undated P&P titled Inventory List, Resident ' s Personal and Resident 1 ' s undated Inventory List were reviewed. LVN 2 stated the P&P indicated all durable medical equipment must be included on the inventory list and signed by the resident or the resident ' s representative. LVN 2 stated Resident 1 ' s Inventory List did not indicate a signature from Resident 1, or Resident 1 ' s (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: 056144 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 056144 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Huntington Park Nursing Center 6425 Miles Avenue Huntington Park, CA 90255 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)