Health inspection·May 7, 2024

F 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure two out of four sampled residents (Resident 1 and Resident 3) were provided assistance with Activities of Daily Living (ADL- such as using the restroom, oral hygiene, walking), by leaving Residents 1 and 3 wet with urine for an extended period of time. Residents Affected - Few This failure placed Resident 1 and 3's needs unmet and the potential for skin breakdown and infections. Findings: a). A review of Resident 1's admission record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including progressive supranuclear opthalmoplegia (a condition that affects the ability to control eye movements at will in all directions), history of falling, and other abnormalities of gait (a particular way of walking) and mobility (ability to move purposefully). A review of Resident 1's care plan titled, Needs assistance with Activity of Daily Living, dated 11/1/2023, indicated to provide assistance as needed. A review of Resident 1's Minimum Data Set (MDS, a standardized assessment and care screening tool) dated 1/29/2024 indicated, Resident 1 had intact cognition. The MDS indicated Resident 1 required maximum assistance with toileting (the ability to maintain hygiene before and after voiding or having a bowel movement) and moderate assistance with personal hygiene. The MDS indicated Resident 1 required maximum assist with toilet transfer. b). A review of Resident 3's admission record indicated Resident 3 was admitted to the facility on [DATE] with diagnoses including, lack of coordination and aphasia (a disorder that affects how you communicate) following cerebral infarction (stroke). A review of Resident 3's care plan titled ,Needs assistance with ADL, dated 4/16/2024, indicated an intervention to provide incontinence care as needed. A review of Resident 3's MDS dated [DATE], indicated Resident 3 was dependent to staff with toileting, showers and tub/ shower transfer. During an interview on 5/6/2024 at 12:57 p.m. with Resident 1, Resident 1 stated staff had been unable to take her to the restroom and waited for two hours before staff could assist her. Resident 1 stated that it happened throughout the day and more so at night. Resident 1 stated that they needed (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: 056218 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 056218 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bell Convalescent Hospital 4900 E. Florence Ave Bell, CA 90201 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)