Health inspection·December 12, 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a resident who was transferred to a General Acute Care Hospital (GACH) on 12/9/2024 due to the resident's combative behavior after he was found with drug paraphernalia (any equipment that is used to produce, conceal, and consume illicit drugs), was readmitted to the facility on ce the resident was treated and cleared by the GACH to return to the facility on [DATE] for one of three sampled residents (Resident 1). This deficient practice resulted in the denial of Resident 1's bed hold (a resident's right to keep a bed vacant and available for seven days after their transfer to the hospital in anticipation of their return to the facility) and him remaining at the GACH for two days after the GACH deemed Resident 1 able to return to the facility. This deficient practice had the potential for Resident 1 to continue to be displaced from his residence. Findings: During a review of Resident 1's admission Record (Face Sheet), the Face Sheet indicated Resident 1 was admitted to the facility on [DATE] with a diagnosis of Parkinson's disease (a progressive disease of the nervous system marked by tremors, muscular rigidity, and slow, imprecise movements). During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool) dated 10/22/2024, the MDS indicated Resident 1's cognition was intact and Resident 1 required supervision or touch assistance (helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity) to complete activities of daily living ([ADLs] activities such as bathing, dressing and toileting a person performs daily). During a review of Resident 1's Nurses Notes dated 12/9/2024, the Nurses Notes indicated Resident 1 was sent to the GACH due to aggressive behavior and danger to self and others. The Nurses Notes indicated Resident 1 was combative and trying to strike the facility staff when drugs and drug paraphernalia was found and confiscated. During a review of Resident 1's Bed Hold Notification form dated 12/9/2024, the Bed Hold Notification form indicated Resident 1 desired a bed hold for a duration of seven days and was verbally notified. During a review of Resident 1's Notice of Transfer/Discharge note (a written or verbal notification that a resident or their representative intends to leave a skilled nursing facility [SNF] or the (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: 056425 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 056425 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Studebaker Healthcare Center 13226 Studebaker Rd Norwalk, CA 90650 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)