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
observation, interview, and record review, the facility failed to notify the physician for one of five sampled
residents (Resident 4), who had a purple skin discoloration on the right upper arm. This deficient practice
resulted in the physician being unaware of the resident's condition and had the potential to delay the care
and services the resident will need.Findings:During a concurrent observation and interview on 2/24/2026 at
11:40 a.m., with Resident 4 in her room, Resident 4 was observed with a purple skin discoloration on her
right upper arm, measuring approximately, more than an inch. Resident 4 stated, I am not sure why I have
the bruise. Maybe when I went to the bathroom the other day, I hit myself in the bathroom. Resident 4
stated she was not sure if the nurse was aware of the bruise and that the nurses had not applied anything
to it. During a review of Resident 4's admission Record, the admission Record indicated Resident 4 was
admitted to the facility on [DATE]. Resident 4's diagnoses included diabetes mellitus (DM-a disorder
characterized by difficulty in blood sugar control and poor wound healing) hypertension (HTN-high blood
pressure) and congestive heart failure (CHF-a heart disorder which causes the heart to not pump the blood
efficiently, sometimes resulting in leg swelling). During a review of Resident 4's History and Physical (H&P)
dated 1/10/2026, the H&P indicated Resident 4 had the capacity to understand and make decisions. During
a review of Residents 4's Minimum Data Set (MDS - a resident assessment tool) dated 1/21/2026, the MDS
indicated Resident 4 had intact cognition. Resident 4 required depending on assistance with activities of
daily living (ADLs) such as dressing, toilet use, personal hygiene, transfer and mobility. During a review of
Resident 4's care plan titled, Potential for skin breakdown / pressure ulcer development related to thin
fragile skin, dated 8/17/2025, the interventions indicated to do daily body checks, monitor/ document/ report
to the doctor when needed, for any changes in skin status, appearance, color, size and notify the nurse of a
new area of skin breakdown, like redness, blisters, bruises or discolorations noted during bath or daily care.
During an interview on 2/24/2026 at 1:54 p.m. with Licensed Vocational Nurse (LVN) 1, LVN 1 she was not
informed about Resident 4's bruises (an injury appearing as an area of discolored skin on the body, caused
by a blow or impact rupturing underlying blood vessels) on the arm and the physician was not notified about
the bruise. LVN 1 stated the bruise should have been assessed for dimensions, redness, or hardness,
determine if the resident was on blood thinner medications and identify the cause of the bruise. During a
review of facility Policy and Procedures (P&P) titled, Skin and Wound Monitoring and Management, dated
4/2025, the P&P indicated the licensed nurse must assess/evaluate a resident's skin at least weekly and
document in the nursing notes, all areas of breakdown, excoriation, or discoloration, or other unusual
findings. The CNA should observe resident skin and identify any areas of skin breakdowns, discolorations,
tears or redness and communicate the findings to the licensed nurse verbally. The Licensed nurses should
acknowledge findings, document pertinent information on resident's clinical records and
(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
02/24/2026
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)
F 0580
response/ obtain and implement treatment order as appropriate.
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056144
If continuation sheet
Page 2 of 2