Inspection·November 6, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Potential for minimal harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and facility P&P review, the facility failed to provide reasonable accommodations to meet the care needs for one of four sampled residents (Resident 2). Residents Affected - Some * The facility failed to ensure Resident 2 had the correct dental toothbrush for oral hygiene. This failure had the potential to negatively impact Resident 2's well-being. Findings: Review of the facility's P&P titled Accommodation of Needs reviewed on 10/7/24, showed the facility shall evaluate and make reasonable accommodations for the individual needs and preferences of a resident. Under the Policy Explanation and Compliance Guidelines, based on individual needs and preferences, the facility will assist the resident in maintaining and/or achieving independent functioning, dignity, and well-being to extent possible. Medical record review for Resident 2 was initiated on 10/25/24. Resident 2 was originally admitted to the facility on [DATE], and readmitted on [DATE]. On 11/6/24 at 0915 hours, a concurrent observation and interview was conducted with Resident 2 and CNA 2. Resident 2 removed the dentures and placed them on a paper towel. CNA 2 brought the emesis basin, short handle brush with bristles on both sides, a cup of water and a bottle of blue solution for mouthwash. Resident 2 used the short handle brush with bristles on the sides to brush their teeth when CNA 2 brought a regular toothbrush. Resident 2 stated CNA 2 gave the short handle brush so Resident 2 used that brush to brush the teeth. CNA 2 stated the small handle brush with bristles on both sides is normally used to clean the dentures, and the regular toothbrush is normally used to clean the resident's teeth. CNA 2 verified they did not provide the regular toothbrush for Resident 2 to brush the teeth. CNA 2 further verified Resident 2 used the short handle brush with bristles to brush the teeth. On 11/6/24 at 1312 hours, an interview was conducted with LVN 4. LVN 4 stated Resident 2 preferred to use the regular toothbrush to brush the teeth. Furthermore, LVN 4 confirmed the short handle brush with bristles on both sides was normally used to clean the dentures. On 11/6/24 at 1515 hours, an interview was conducted with the DON. The DON verified Resident 2 was to use two brushes, the brush with bristles on both sides was used to clean the dentures and the regular toothbrush was for the teeth. 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 5 Event ID: 056169 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 056169 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/06/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alamitos West Health & Rehabilitation 3902 Katella Avenue Los Alamitos, CA 90720 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)