Health inspection·January 24, 2024

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. Based on interview and record review the facility failed to re-admit one of one sampled resident (Resident 1). Resident 1 who was ready to be discharged from the general acute hospital (GACH 2) on 1/19/24, the facility refused to re-admit Resident 1. This deficient practice resulted in Resident 1 not given his right to return to the facility. Findings: During a review of the admission Record indicated the facility admitted Resident 1 on 9/22/23 with diagnoses including morbid obesity (more than 80 to 100 pounds [lbs., unit of measurement] of their ideal body weight) and chronic obstructive respiratory disease (COPD, group of diseases that cause airflow blockage and breathing related problems). During a review of the Minimum Data Set (MDS, standardized care and screening tool) dated 9/25/23, indicated Resident 1 was cognitively intact (mental process involved in knowing, learning, and understanding). Resident 1 needed two-person physical assistance with eating, personal hygiene and three-person physical assistance with bed mobility, dressing, toilet use and bathing. During a review of the Situation Background Communication Form (SBAR, communication tool that share information among healthcare team about resident condition) and Progress Note dated 12/14/23 at 10:45 a.m., indicated Resident 1 was transferred to GACH 1 on 12/14/23 due to altered mental status (AMS, abnormal state of alertness or awareness). Resident 1 was drowsy and lethargic (decrease in consciousness). The paramedics were called and transferred Resident 1 to GACH 1. During a review of the GACH 2 Inpatient admission Face Sheet (a document that gives a patient's information at a quick glance) indicated Resident 1 was transferred from GACH 1 to GACH 2 on 1/3/24 at 2:38 p.m. During a review of the GACH 2 Discharge Plan Treatment Team Communication dated 1/19/24 at 3:06 p.m., indicated the GACH 2 case manager (CM) called the facility and informed the facility that Resident 1 was ready to return to the facility. The facility informed the CM that Resident 1 was . off bed hold and will not accept patient (Resident 1) back. During a review of the GACH 2 Discharge Plan Treatment Team Communication dated 1/22/24 at 3:27 p.m., indicated the GACH 2 CM called the facility, and the facility informed the CM that Resident 1 .was out of bed hold and has no bed available. (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: 056244 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 056244 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/24/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Grand Park Convalescent Hospital 2312 West 8th Street Los Angeles, CA 90057 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)