Health inspection·May 16, 2025

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 Based on observation, interview, and record review, the facility failed to provide materials to facilitate communication for a resident with speech disabilities for one of four sampled residents (Resident 1). Residents Affected - Few This deficient practice had the potential to prevent the resident from communicating with the staff and had the potential to delay receiving care/treatment the resident needed. Findings: During a review of Resident 1's admission Record, the admission Record indicated the facility admitted Resident 1 on 5/27/2021 and readmitted the resident on 5/12/2025 with diagnoses including intracerebral (within the brain) hemorrhage (the dramatic and sudden loss of blood), seizure (a sudden, temporary disruption in brain electrical activity that can cause involuntary changes in body movement, behavior, sensation, or awareness), and gastrostomy (the creation of an artificial external opening into the stomach for nutritional support) with dysphagia (difficulty swallowing). During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool) dated 3/10/2025, the MDS indicated Resident 1's speech was unclear such as slurred or mumbled words and the resident's cognitive (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) skills for daily decision making was severely impaired. The MDS further indicated that the resident was dependent on staff with oral/toileting/personal hygiene and upper/lower body dressing and needed maximal assistance from staff with bed mobility (movement). During a review of Resident 1's General Acute Care Hospital (GACH) Skilled Nursing Facility Transfer Orders (SNFTO) dated 5/12/2025, the SNFTO indicated dysphasia was included in active problems in the physician report. During a concurrent observation and interview on 5/16/2025 at 8:38 a.m., with Certified Nursing Assistant 1 (CNA 1) and Registered Nurse 1 (RN 1) in Resident 1's room, observed Resident 1 lying in bed coughing and pointing to his (Resident 1) mouth area but unable to describe what Resident 1 needed. CNA 1 stated that Resident 1 was able to answer 'yes' or 'no' to questions but was unable to request what Resident 1 needed verbally. When CNA 1 was asked if they had a communication board or some tools to communicate with Resident 1, CNA 1 stated that there were no communication boards or tools in Resident 1's room. When RN 1 was asked how RN 1 communicated with Resident 1, RN 1 stated that Resident 1 was not able to talk and state what he needed. RN 1 stated if a communication board was available then it would be helpful to figure out what Resident 1 wanted, but RN 1 could not tell what Resident 1 wanted at that moment. (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 4 Event ID: 056367 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 056367 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Rehabilitation Center of North Hills 9655 Sepulveda Boulevard North Hills, CA 91343 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)