Health inspection·May 19, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure accident and hazard free environment for one of three sampled residents (Resident 1). The facility failed to ensure: 1. Resident 1 ' s bed footboard was not broken and left on the floor for several hours. 2. Resident 1 ' s feet (at ankle level) were not dangling at the foot of the bed. 3. Staff did report and request maintenance for the broken footboard. This deficient practice had the potential for Resident 1 to sustain fall and injury. Findings: A review of Resident 1 ' s admission record indicated Resident 1 was initially admitted to the facility on [DATE] with a diagnosis of not limited to unspecified abnormalities of gait and mobility, encephalopathy (a disease damaged the functions of the brain), myocardial infarction (heart attack, happens when blood flow to the heart muscle is blocked). A review of Resident 1 ' s Minimum Data Set (MDS, a assessment tool) dated 3/9/2025 indicated, Resident 1 had a cognitive (mental action or process of acquiring knowledge and understanding) loss, unclear speech, has difficulty communicating to make self-understood, is wheelchair bound for mobility, requires maximal assistance (helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) to sit and stand, to transfer from bed to chair. During an observation on 5/19/2025 at 10:35 AM, Resident 1 ' s bed footboard was broken and left on the floor. Resident 1 ' s feet at ankle level hanging at the foot of the bed. Resident 1 was observed lying in bed, right hand and lower extremities weakness. Resident 1 was unable to verbalize how long the footboard was left on the floor and the last time he was seen by a staff member. During an interview on 5/19/2025 at 12:15 PM with Licensed Vocational Nurse 1(LVN1) stated, Resident 1 is dependent on staff for mobility, to turn in bed right or left. LVN1 observed Resident 1 ' s footboard broken and lying on the floor, Resident 1 ' s feet dangling. LVN1 stated, I saw the footboard on the floor this morning, not sure of the exact time. Stated, it might have been broken, it was not supposed to be left on the floor. It is a safety hazard. Resident 1 could potentially slide down and fall. (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 2 Event ID: 056195 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 056195 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LA Brea Rehabilitation Center 505 N. LA Brea Avenue Los Angeles, CA 90036 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)