F 0677
Provide care and assistance to perform activities of daily living for any resident who is unable.
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 assist one of three residents (Resident 2) to shower at least
twice a week.This deficient practice had the potential to result in poor hygiene for Resident 2 which can
lead to poor self-image and discomfort. Findings:During a review of Resident 2's admission Record, the
admission Record indicated Resident 1 was originally admitted to the facility on [DATE] with diagnoses
including muscle weakness, difficulty in walking, and history of traumatic brain injury (type of brain injury
that occurs when an external force causes damage to the brain).During a review of Resident 2's Minimum
Data Set (MDS), a resident assessment tool, dated 5/23/2025, the MDS indicated Resident 2's cognition
was severely impaired. The MDS indicated Resident 2 needed partial assist (helper does less than half the
effort to complete the task) with showring and toileting hygiene, and supervision with oral and personal
hygiene.During a review of Resident 2's Care Plan report, the care plan for Activities of Daily Living (ADLsactivities such as bathing, dressing and toileting a person performs daily), initiated 4/1/2022, indicated
Resident 2 required assistance with ADLs. A care plan intervention indicated to assist as needed with
showers. Another intervention indicated to ensure Resident 2 showered two to three times a week. During a
concurrent interview and record review on 7/29/2025 at 1:54 p.m., with Registered Nurse (RN)1, Resident
2's Shower Sheets for July 7/2025 and Point of Care (POC) response History from 6/30/2025 to 7/29/2025
were reviewed. RN 1 confirmed Resident 2 was not assisted with showers at least twice a week.During an
interview on 7/29/2025 at 12:59 p.m., with the Director of Nursing (DON), the DON stated residents need to
be assisted to shower at least twice a week for personal hygiene. During a review of the facility's policy and
procedure (P&P) titled, Assistance with ADL Care, released 5/2025, the P&P indicated facility will assist to
residents with performance of their activities of daily living. During a review of the facility's P&P titled,
Shower, undated, the P&P indicated it was the policy of the facility to promote cleanliness and comfort.
Residents Affected - Few
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:
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
07/29/2025
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)
F 0761
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted
professional principles; and all drugs and biologicals must be stored in locked compartments, separately
locked, compartments for controlled drugs.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review, the facility failed to ensure medication was not left on one of three
resident's (Resident 1) bedside table.This deficient practice had the potential to result in visitors, residents,
and staff unauthorized access and use of Resident 1's medication and could result in a medication
error.Findings:During a review of Resident 1's admission Record, the admission Record indicated Resident
1 was admitted to the facility on [DATE] with diagnoses including hemiplegia (total paralysis of the arm, leg,
and trunk on the same side of the body) and hemiparesis (condition characterized by weakness or partial
paralysis affecting one side of the body) affecting left dominant side, type 2 diabetes (a disorder
characterized by difficulty in blood sugar control and poor wound healing), and low back pain. During a
review of Resident 1's Minimum Data Set ([MDS], a resident assessment tool), dated 6/21/2025, the MDS
indicated Resident 1's cognitive skills (ability to think and reason) for daily decision-making was intact. The
MDS indicated Resident 1 required supervision with eating, partial assistance with (helper does more than
half the effort) with personal hygiene and oral hygiene.During a concurrent observation and interview on
7/29/2025 at 1:04 p.m., with Registered Nurse (RN)1, in Resident 1's room, a used tube of Diclofenac
Sodium Topical Gel, 1% (medication to relieve pain) was observed on Resident 1's nightstand. RN 1 stated
medication should not be stored at the bedside for resident safety, and the medication was an old
medication and was not part of Resident 1's medication ordered by the physician in the facility.During an
interview on 7/29/2025 at 12:59 p.m. with the Director of Nursing (DON), the DON stated medication should
not be left at resident's bedside for residents' safety. During a review of the facility's policy and procedure
(P&P) titled, Storage of Medications, undated, the P&P indicated Medications were stored safely, securely,
and orderly manner. The P&P indicated the medication supply was accessible only to staff members
lawfully authorized to administer medications.
Event ID:
Facility ID:
056433
If continuation sheet
Page 2 of 2
