Health inspection·March 26, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to complete a change of condition (CIC/COC- noticeable shift or alteration in a patient's physical, mental, or functional stated, requiring attention and potentially promoting further medical evaluation or intervention) evaluation for three out of five residents when Resident 2, Resident 3, and Resident 5 were exposed to Coronavirus disease ([COVID 19] an infectious disease caused by the SARS-SoV-2 virus). Residents Affected - Some This failure has the potential to result in missing identification of potential symptoms or complications, risking the health and safety of the residents. Findings: a. During a review of Resident 2's admission Record, the admission Record indicated the facility admitted Resident 2 on 12/27/2024 with diagnosis including Hemophilus influenzae (a type of bacteria that can cause various infections, especially in children, ranging from mild ear infections to serious illnesses like meningitis) During a review of Resident 2's Minimum Data Set (MDS- a resident assessment tool), dated 1/3/2025, indicated Resident 2 was cognitively (functions your brain uses to think, pay attention, process information, and remember things) intact. The MDS indicated Resident 2 required maximal assistance (helper does more than half the effort to complete task) with oral hygiene, setup or clean-up assistance with eating, dependent (helper does all the effort) with toileting hygiene and showering. During a review of Resident 2's Order Summary Report, orders as of 3/26/2025, the Order Summary Report indicated an order for novel respiratory precautions for 10 days due to Covid 19 exposure on 3/19/2025. During a review of Resident 2's Change in Condition evaluation, for the month of March 2025, the CIC evaluation indicated, the facility did not complete the CIC evaluation when Resident 2 was exposed to COVID 19. b. During a review of Resident 3's admission Record, the admission Record indicated the facility readmitted Resident 3 on 2/11/2025 with diagnoses including pneumonia (an infection of the lungs that may be caused by bacteria, viruses, or fungi) and influenza (a highly contagious viral infection that primarily affects the respiratory system). During a review of Resident 3's MDS, dated [DATE], indicated Resident 3's cognitive (functions your brain uses to think, pay attention, process information, and remember things) skills for daily (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: 056433 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 056433 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/26/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vermont Healthcare Center 22035 S. Vermont Avenue Torrance, CA 90502 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)