Health inspection·May 1, 2025

F 0553 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Allow resident to participate in the development and implementation of his or her person-centered plan of care. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to involve one of one resident (Resident 1) and/or responsible party in the Interdisciplinary team (IDT) conference after Resident 1 fell on 4/3/2025. This deficient practice had the potential to result in poor quality of care and a delay of care and services. Findings: During a review of Resident 1 ' s admission Record, the admission record indicated Resident 1 was originally admitted to the facility on [DATE] with diagnosis including hypoglycemia (low blood sugar) and type 2 diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing). During a review of Resident 1 ' s Minimum Data Set ([MDS] a resident assessment tool) dated 4/1/2025, the MDS indicated Resident 1 ' s cognition (ability to think and reason) was intact. The MDS indicated Resident 1 needed set up assistance when eating and oral hygiene, maximal assistance (helper does more than half he effort) with toileting hygiene, and showering. During a concurrent phone interview and record review on 5/2/2025 at 11:42 a.m. with Registered Nurse (RN) 1, Resident 1 ' s SBAR (Situation background Assessment Request)- fall Report Incident, dated 4/3/2025 at 7:07 p.m. The report indicated on 4/3/2025 at 5:55 p.m. Resident 1 was found after a fall in front of the bathroom door. The IDT Notes indicated nursing, Rehabilitation team, Dietary and Activities were all part of the meeting. RN 1 stated the resident, or family was not involved in the IDT meeting, and they should have been involved. During a phone interview on 5/2/2025 at 10:40 a.m. with the Director of Nursing (DON), the DON stated the Resident, or family should be involved in IDT Care conferences. During a review of the facility ' s policy and procedure (P&P) titled, Care Plans, Comprehensive, revised 12/2017, the P&P indicated a comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is developed and implemented for each resident with the collaboration of the resident and IDT team to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being. 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 4 Event ID: 056150 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 056150 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/01/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Catered Manor Care Center 4010 N Virginia Rd. Long Beach, CA 90807 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)