Inspection·April 3, 2025

F 0557 Level of Harm - Potential for minimal harm Residents Affected - Some Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility P&P review, the facility failed to ensure one of four sampled residents (Resident 1) was treated with dignity and respect. This failure had the potential to negatively affect Resident 1's well-being. Findings: Review of the facility's P&P titled Promoting/Maintaining Resident Dignity revised 10/2022 showed to speak respectfully to theresidents. Medical record review for Resident 1 was initiated on 3/7/25. Resident 1 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 1's MDS assessment dated [DATE], showed Resident 1 was cognitively intact with a BIMS score of 15 (cognitively intact). On 4/1/25 at 1059 hours, an observation was conducted of Resident 1. Resident 1 was observed sitting in his wheelchair at his doorway, calling CNA 3 asking for her name. CNA 3 turned around and stated her name. Resident 1 was observed calling CNA 3 by her name; however, CNA 3 did not respond and walked into another resident's room. When CNA 3 exited the other resident's room, Resident 1 began calling CNA 3 by her name again. CNA 3 turned around and responded to Resident 1 by stating what. On 4/1/25 at 1106 hours, an interview was conducted with CNA 3. When asked how she responded to Resident 1 when he called her name, CNA 3 stated, she said what. When asked if theresponse was respectful, CNA 3 stated, oh, we are always just chill. When asked if CNA 3 had cared for Resident 1 before, CNA 3 stated, oh yeah, all the time. On 4/1/25 at 1109 hours, an interview was conducted with Resident 1. When asked how he felt about CNA 3's response when he called her name, Resident 1 stated, I've been waiting for 30 minutes. When asked how he felt with CNA 3's response, Resident 1 stated, not 100%, I feel like I am working for her. On 4/2/25 at 1346 hours, an interview was conducted with CNA 2. When asked how the CNA would respond when a resident has a request, CNA 2 stated, to ask what do you need. When asked if responding what was respectable, CNA 2 stated, no, that's not okay. On 4/3/25 at 1505 hours, an interview with RN 1 was conducted. When asked if a staff member (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 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 04/03/2025 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)