Health inspection·February 19, 2025

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one of three residents reviewed (Resident 1), who was receiving Quetiapine (a medication used to treat bipolar disorder [a mental disorder that results in severe sadness and manic or extreme joy or elated behavior) was monitored for the specific behavior of paranoid delusions (false beliefs that someone is being threatened or mistreated) as indicated for use of the medication. This deficient practice placed Resident 1 at risk unnecessary use of medication and for mismanagement of her mental disorder and expose her to potential side effects associated with taking Quetiapine, such as drowsiness that could lead to accidents and falls. Findings: A review of Resident 1 ' s admission Record indicated the resident was admitted on [DATE] with diagnoses that included schizophrenia (a mental illness that is characterized by disturbances in thought), mood disorders, and dementia (a progressive state of decline in mental abilities). A review of Resident 1 ' s History and Physical (H&P), dated 1/24/2025, indicated the resident does not have the capacity to understand and make decisions. A review of Resident 1 ' s Minimum Data Set (MDS – a federally mandated resident assessment tool), dated 1/27/2025, indicated the resident had moderately impaired cognition (the ability to think and process thoughts). A review of Resident ' s Order Summary Report, dated 2/14/2025, indicated a physician ' s ordered for the resident to take Quetiapine Fumarate Oral Tablet 25 MG (MG, milligram, a unit of measuring weight) give 1 tablet by mouth at bedtime for schizophrenia manifested by (m/b) paranoid delusions. A review of Resident ' s Medication Administration Report (MAR) for the months of 1/2025 and 2/2025, indicated the resident was being administered Quetiapine Fumarate. The MAR did not indicate that Resident 1 ' s behavior of paranoid delusions was being monitored by staff. A review of Resident 1 ' s nursing progress notes for the months of 1/2025 and 2/2025, did not indicate documented evidence that the resident ' s specific behavior of paranoid delusions was identified and monitored. (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: 056317 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 056317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Haven Care Center 409 W. Glenoaks Blvd. Glendale, CA 91202 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)