Inspection·December 12, 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 interview and medical record review, the facility failed to meet the needs and preferences for one of three sampled residents (Resident 1). Residents Affected - Some * The facility failed to provide Resident 1 a bath when he requested a bath on 11/24/24. This failure led to the resident feeling frustrated, which posed the risk to negatively impact the resident's physical and emotional 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, except when the health and safety of the individual or other residents would be endangered. Medical record for Resident 1 was initiated on 12/4/24. Resident 1 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 1's History and Physical examination dated 9/26/24, showed Resident 1 had a fluctuating capacity to understand and make decisions. Review of Resident 1's MDS Annual assessment dated [DATE], showed the BIMS score of 12 (moderate cognitive impairment). On 12/3/24 at 1645 hours, a telephone interview was conducted with Resident 1's family member. Family Member 1 stated Resident 1 returned from the hospital on [DATE], and refused the shower as scheduled on that day. Family Member 1 further stated Resident 1 requested for a bath on 11/24/24;however, Resident 1 was not given a shower until 11/25/24, because the CNA assigned to the resident worked a double shift and needed to go to break. Review of Resident 1's Task ADL – Bathing failed to show a bath was given to Resident 1 on 11/24/24 as requested. On 12/4/24 at 1259 hours, an interview was conducted with Resident 1. Resident 1 stated he felt frustrated when he requested for a bath because he wanted to feel clean, and the staff did not help him. On 12/11/24 at 1507 hours, an interview and concurrent medical record review was conducted with the DSD. The DSD verified the task would only show the bathing on the day when a bath was given to the (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 11 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 12/12/2024 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)