Health inspection·September 10, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one of two sampled residents (Resident 1) had a comprehensive care plan in place to include in and out self-catheterization (a procedure where a thin tube (catheter) is temporarily inserted into the bladder to drain urine, then immediately removed). This deficient practice placed Resident 1 at risk for insufficient care and services related to self-catheterization.Findings: During a review of Resident 1's Face Sheet (front page of the chart that contains a summary of basic information about the resident), the Face Sheet indicated Resident 1 was admitted on [DATE] with diagnoses that included fracture of the vertebra (one of the bones that make up the spinal column), paraplegia, and retention of urine (unable to urinate). During a review of Resident 1's History and Physical (H&P), dated 4/10/2025, the H&P indicated Resident 1 had the capacity to understand and make decisions. During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool), dated 7/15/2025, the MDS indicated Resident 1 was able to make himself understood and had the ability to understand others. The MDS further indicated Resident 1 was cognitively intact (ability to reason, understand, remember, judge, and learn), had no impairment to the upper and lower extremities (pertaining to the arms and legs), and used a wheelchair for mobility. During a review of Resident 1's Order Summary Report, dated 9/10/2025, the Order Summary Report indicated Resident 1 had an order to allow for in and out selfcatheterization. During a concurrent interview and record review on 9/9/2025 at 11:50 a.m. with the Minimum Data Set Nurse (MDSN), Resident 1's Care Plan and Order Summary Report was reviewed. The MDSN reviewed Resident 1's Order Summary Report and stated Resident 1 had an order to self-catheterize himself and Resident 1 should have a care plan to reflect that. The MDSN reviewed Resident 1's care plan and stated Resident 1 did not have a care plan for in and out self-catheterization and was important to have one to identify the needs of Resident 1 and to guide their care. During a review of the facility's policy and procedure (P&P) titled Care Planning, dated 1/2021, the P&P indicated the interdisciplinary team (IDT- ) shall develop and implement a comprehensive person-centered care plan for each resident, consistent with the resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the comprehensive assessment. 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 4 Event ID: 056267 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 056267 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Camino Healthcare 13922 Cerise Avenue Hawthorne, CA 90250 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)