Inspection visit

InspectionMarch 30, 2025

LAKE BALBOA CARE CENTERCMS #0561808 citations on this visit

8 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 8 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide care in a manner that maintained or enhanced a resident`s dignity and respect in full recognition of their individualities for one of one sampled resident (Resident 26) when Certified Nursing Assistant 2 (CNA 2) was standing over the resident while assisting him during a meal. This deficient practice had the potential to negatively affect the resident`s psychosocial wellbeing and loss of dignity. Findings: During a review of Resident 26's admission Record (face sheet), the admission Record indicated that the facility originally admitted the resident on 3/28/2024, and readmitted on [DATE], with diagnoses including Parkinson`s disease (a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movements), dysphagia (difficulty swallowing), depression (a mood disorder that causes a persistent feeling of sadness and loss of interest), and need for assistance with personal care. During a review of Resident 26's Nutrition/Hydration Risk Evaluation form dated 3/18/2025, the evaluation indicated that the resident was slow to response and required verbal cues to feed himself. During a concurrent observation and interview on 3/29/2025 at 7:50 a.m., inside Resident 26`s room, Certified Nursing Assistant 2 (CNA 2) was standing over Resident 26 while feeding him. CNA 2 stated that she always stands over residents and feed them because it is easier for her. During a concurrent observation and interview on 3/29/2025 at 7:52 a.m. with MDS Coordinator 1 (MDSC 1), inside Resident 26`s room, MDSC 1 observed CNA2 standing over Resident 26 while assisting him with his breakfast. MDSC 1 stated staff are able to assist the residents with feeding in standing or sitting positions. During an interview on 3/29/2025 at 8:00 a.m., with the Director of Nursing (DON), the DON stated staff are required to assist residents with feeding in a sitting position so they can maintain their dignity. During a review of facility`s Policy and Procedure (P&P) titled Feeding the Dependent Resident, last reviewed 1/2025, the P&P indicated that some residents cannot feed themselves because of severe weakness, doctor`s order, or impaired ability so they cannot use their hands. Sit at eye level of 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 9 Event ID: 056180 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 056180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Balboa Care Center 16955 Vanowen Street Van Nuys, CA 91406 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 0550 resident. This allows social interaction and better observation if any swallowing difficulty. Level of Harm - Minimal harm or potential for actual harm During a review of facility`s Policy and Procedure (P&P) titled Dignity and Respect, last reviewed 1/2024, the P&P indicated that staff shall display respect for residents when speaking with, caring for, or talking about them, as constant affirmation of their individuality and dignity as human being. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056180 If continuation sheet Page 2 of 9 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 056180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Balboa Care Center 16955 Vanowen Street Van Nuys, CA 91406 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 0583 Keep residents' personal and medical records private and confidential. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to maintain privacy of confidential information for one of three sampled residents (Resident 94), when Licensed Vocational Nurse 1 (LVN 1) left Resident 94's electronic health record (EHR- a digital version of a patient's paper chart) open and unattended. Residents Affected - Few This deficient practice violated the resident's right to privacy and confidentiality of medical records. Findings: During a review of Resident 94's admission Record, the admission Record indicated that the facility admitted Resident 94 on 3/17/2025 with diagnoses including acute pulmonary edema (a condition where fluid accumulates in the lungs, making it difficult to breathe) and heart failure (occurs when the heart can't pump enough blood to meet the body's needs, leading to symptoms like shortness of breath, fatigue, and swelling). During a review of Resident 94's Minimum Data Set (MDS - a federally mandated resident assessment tool), dated 3/21/2025, the MDS indicated that the resident had the ability to sometimes understand others and the ability to sometimes makes self-understood. The MDS further indicated that Resident 94 is totally dependent on staff for toileting hygiene, shower, lower and upper body dressing. During a concurrent medication pass observation and interview on 3/29/2025 at 4:47 p.m., with Licensed Vocational Nurse 1 (LVN 1), observed LVN 1 left the computer screen open, displaying Resident 94` medication list and photo, while stepping away from the medication cart to enter Resident 94's room. During an interview with LVN 1, LVN 1 stated that she should have ensured that Resident 94`s electronic chart was not accessible to anyone while she stepped away from the computer which was on top of the medication cart. LVN 1 stated that it is a violation of the Health Insurance Portability and Accountability Act (HIPAA) to have the resident's health information visible to unauthorized persons. During a review of The Health Insurance Portability and Accountability Act (HIPAA) of 1996, it indicated the HIPAA Security Rule protects specific information cover the Privacy Rule law applies fully to nursing homes, requiring them to protect the privacy of residents' health information (PHI) by implementing appropriate safeguards, including technical, administrative, and physical measures to prevent unauthorized access, use, or disclosure of this information, particularly electronic protected health information (ePHI). During a review of the facility's policy and procedure (P&P), titled, Pharmacy Services for Nursing Facilities, last reviewed on 1/15/2025, the policy indicated that during administration of medications, the medications cart is kept closed and locked when out of sight of the medication nurse or aide .in addition, privacy is maintained always for all resident information by closing the computer screen when not in use . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056180 If continuation sheet Page 3 of 9 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 056180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Balboa Care Center 16955 Vanowen Street Van Nuys, CA 91406 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure licensed nurses provided non-pharmacological interventions (any type of healthcare intervention which is not primarily based on medication) to one of three sampled residents (Resident 15) prior to administering as needed (prn) opioid ([narcotic-treats moderate to severe pain) pain medication. Residents Affected - Few This deficient practice had the potential to place the resident at increased risk of experiencing adverse side effects (undesired harmful effect resulting from a medication or other intervention) from use of opioids. Findings: During a review of Resident 15's admission Record, the admission Record indicated the facility admitted the resident on 1/03/2025 with diagnoses including atrial fibrillation (a heart condition that causes an irregular heartbeat) and pneumonia (infection that inflames air sacs in one or both lungs, which may fill with fluid). During a review of Resident 15's Minimum Data Set (MDS - a federally mandated resident assessment tool), dated 1/08/2025, the MDS indicated that the resident had intact cognition (undamaged mental abilities, including remembering things, making decisions, concentrating, or learning). The MDS further indicated that Resident 15 required substantial-to-maximal assistance for showering, toileting and personal hygiene, dressing and chair-to-bed transfer. During a review of Resident 15's physician's orders, the physician's orders indicated the following orders: - Percocet Oral Tablet ([Oxycodone with Acetaminophen] medication used to treat moderate to severe pain) 5-325 milligrams (mg - unit of measurement), give one tablet by mouth every eight (8) hours as needed for severe pain 7-10/10 (numerical scale used to measure pain with 0 being no pain and 10 being the worst pain), ordered on 1/06/2025. - Provide non-pharmacological intervention for pain, including repositioning, quiet environment, relaxation, distraction, music, and massage every shift. During a concurrent interview and record review on 3/29/2025 at 6:30 p.m., with the Director of Nursing (DON), reviewed Resident 15's Medication Administration Record (MAR - a report that serves as a legal record of the drugs administered to a resident at a facility by a health care professional) for the month of 03/2025. The DON verified the dates when Percocet were administered and also verified that there were no non-pharmacologic interventions provided to Resident 15 prior to administration of Percocet on the following dates: 3/20/2025 at 9:18 p.m. 3/21/2025 at 9:45 p.m. 3/26/2025 at 8:45 p.m. The DON stated that non-pharmacologic interventions should be attempted first because the pain (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056180 If continuation sheet Page 4 of 9 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 056180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Balboa Care Center 16955 Vanowen Street Van Nuys, CA 91406 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 0697 Level of Harm - Minimal harm or potential for actual harm might just be caused by Resident 15's position in bed, or other external factors that are causing the pain. The DON stated that when the non-pharmacologic interventions are not effective, then that is the time to administer Percocet. The DON stated that the use of narcotic pain medication such as Percocet can increase the risk of a resident experiencing adverse effects of the medication such as dizziness which can lead to fall and respiratory depression. Residents Affected - Few During a review of Resident 15`s Care Plan (CP-are written tools that outline nursing diagnoses, interventions, and goals) for Acute or Chronic Pain dated 1/03/2025, the CP indicated a goal for the resident to have no interruption in normal activities due to pain through the review date. During a review of the facility's policy and procedure titled, Pain Recognition and Management, last reviewed and revised on 2/2025, the policy and procedure indicated The care plan will include preventative or care interventions (pharmacological and non-pharmacological) to manage and/or prevent pain and consider the resident needs, preferences, and goals . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056180 If continuation sheet Page 5 of 9 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 056180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Balboa Care Center 16955 Vanowen Street Van Nuys, CA 91406 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure a resident's indwelling catheter (a flexible tube used to empty the bladder and collect urine in a drainage bag) tubing was not touching the floor for one of one sampled resident (Resident 195) reviewed under indwelling catheter. Residents Affected - Few This deficient practice had the potential to result in contamination of the resident's care equipment and risk of transmission of bacteria that can lead to infection. Findings: During a review of Resident 195's admission Record, the admission Record indicated the resident was admitted to the facility on [DATE], with diagnoses including fracture of neck of femur (a break in the uppermost part of thighbone, next to hip joint), hypertension (a condition in which blood pressure is higher than normal), and acute kidney failure (a condition in which the kidneys are damaged and cannot filter blood well). During a review of Resident 195`s Minimum Data Set (MDS - a standardized assessment and care screening tool), dated 03/27/2025, the MDS indicated the resident had a mildly impaired cognition (a slight decline in mental abilities, memory and completing complex tasks) and required substantial assistance from staff for toileting hygiene, shower, dressing and personal hygiene. During the review of Resident 195's History and Physical (H&P- a comprehensive assessment of a patient's health, performed by a doctor during an initial visit) dated 3/24/2025, the H&P indicated Resident 195 had fluctuating capacity to understand and make decisions. During the review of Resident 195's Order Summary Report dated 3/29/2025, the Order Summary report indicated an order for indwelling catheter and indwelling catheter care every shift dated 3/25/2025. During the review of Resident 195's Care plan (a document that outlines the actions and interventions needed to address a resident's health and care needs), dated 3/23/2025, the care plan indicated to position catheter bag and tubing below the level of the bladder and away from the entrance room door. During an observation and interview on 03/29/2025 at 10:08 a.m., observed Resident 195 in bed with the indwelling catheter tubing hanging on the right side of the bed and touching the floor. During an observation and interview on 03/29/2025 at 10:09 a.m., with Licensed Vocational Nurse 2 (LVN 2), LVN 2 stated the catheter tubing was touching the floor. LVN 2 stated that indwelling catheter tubing should not touch the floor because of risk of infection to Resident 195. During an interview on 03/29/2025 at 10:10 a.m., with the Director of Nursing (DON), the DON stated that the indwelling catheter tubing should not touch the floor. The DON stated that the indwelling catheter tubing touching the floor had the potential for bacterial transmission, potentially leading to infection. During a review of the facility`s policy and procedure titled Indwelling Urinary Catheter Care, last reviewed on 2/2025, the policy and procedure indicated :It is the policy of this facility that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056180 If continuation sheet Page 6 of 9 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 056180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Balboa Care Center 16955 Vanowen Street Van Nuys, CA 91406 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 0880 each resident with an indwelling catheter will receive catheter care daily and as needed (PRN)to promote hygiene, comfort, and decrease the risk of infection. 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: 056180 If continuation sheet Page 7 of 9 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 056180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Balboa Care Center 16955 Vanowen Street Van Nuys, CA 91406 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 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide at least 80 square (sq.) feet (ft.) per resident for ten (10) of 26 resident rooms (room [ROOM NUMBER], 103, 105, 107, 110, 112, 115, 117, 119, and 121). The room size for these rooms had the potential to have inadequate space for resident care and mobility. Findings: During the recertification survey from 3/28/2025 to 3/30/2025 the residents residing in the rooms with an application for room variance were observed with sufficient amount of space for residents to move freely inside the rooms. There was adequate room for the operation and use of wheelchairs, walkers, or canes. The room variance did not affect the care and services provided by nursing staff for the residents. The Administrator submitted an application for the Room Variance Waiver, dated 3/28/2025, for 10 resident rooms. The room waiver request showed the following: Room Square Footage (sq ft) Bed Capacity Sq Ft per Resident 101 152 2 76 102 154 2 77 105 159 2 79.5 107 156 2 78 110 310 4 77.5 112 312 4 78 115 156 2 78 117 154 2 77 119 158 2 79 121 154 2 77 The minimum requirement for a 2-bed room should be at least 160 sq. ft. The minimum requirement for 4 -bed room should be at list 360 sq. ft. During a review of the room waiver letter dated 1/12/2025, indicated that, each room listed on the Client Accommodation Analysis has no interfere with free movement of wheelchairs and/ or sitting (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056180 If continuation sheet Page 8 of 9 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 056180 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Lake Balboa Care Center 16955 Vanowen Street Van Nuys, CA 91406 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 0912 Level of Harm - Potential for minimal harm Residents Affected - Some devices. There is enough space to provide for each resident care, dignity and privacy, and the rooms are in accordance with the special needs of the residents and would not have an adverse effect on the residents' health and safety or impede the ability of any resident in the rooms to attain his or her highest practicable well-being. During a resident council group interview on 3/29/2025 at 10 a.m., residents stated they do not have any problem physically getting around their room. The residents stated their nurses were able to provide them with good care and privacy. During multiple room observations conducted in Rooms 101, 103, 105, 197, 110, 112, 115, 117, 119 and 121 from 3/28/2025 to 3/30/2025, between the hours of 7:30 a.m. - 9 p.m., it was observed the that nursing staff had adequate space to provide care to the residents, and that each resident was provided privacy curtains for privacy; and the rooms had two modes of egress, one with direct access to the corridors and another leading to the outside of the building. During an interview on 3/29/2025 at 2:12 p.m., with Resident 41 and Resident 31, both residents verbalized the rooms afforded them adequate space to accommodate their needs and staff were able to provide care safely and without restrictions. During an interview on 3/29/2025 at 2:15 p.m., with Certified Nursing Assistant 1 (CNA 1) and Licensed Vocational Nurse 2(LVN 2), both CNA 1 and LVN 2 did not state concerns regarding the lack of space while providing care for the residents. During a review of the facility's policy and procedure titled, Resident Rooms, last reviewed 2/2025, indicated: It is policy of this facility that a resident room must .measure at least 80 square feet per resident in multiple resident bedrooms, and at least 100 square feet in a single resident room. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056180 If continuation sheet Page 9 of 9

Reading this as a family member? Your long-term care ombudsman is a free advocate for residents and families.

Citations

8 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0550GeneralS&S Dpotential for harm
F550 - Resident Rights
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
0583GeneralS&S Dpotential for harm
F583 - Privacy and Confidentiality
Keep residents' personal and medical records private and confidential.
0697GeneralS&S Dpotential for harm
F697 - Pain Management
Provide safe, appropriate pain management for a resident who requires such services.
0880GeneralS&S Dpotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0912GeneralS&S Bno actual harm
F912 - Measure at least 80 square feet per resident in multiple resident
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
0324GeneralS&S Dpotential for harm
Provide properly protected cooking facilities.
0511GeneralS&S Dpotential for harm
Have properly installed electrical wiring and gas equipment.
0920GeneralS&S Dpotential for harm
F920 - Dining and Resident Activities
Ensure proper usage of power strips and extension cords.

FAQ · About this visit

Common questions about this visit

What happened during the March 30, 2025 survey of LAKE BALBOA CARE CENTER?

This was a inspection survey of LAKE BALBOA CARE CENTER on March 30, 2025. The surveyor cited 8 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at LAKE BALBOA CARE CENTER on March 30, 2025?

Yes, 8 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her right..."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CMS Care Compare public records. Dataset last refreshed June 8, 2026. If you believe any information is inaccurate, report it here.

Inspection·March 30, 2025