Health inspection·September 22, 2025

F 0559 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made. Based on interviews and record review, the facility failed to obtain informed consent and provide written notice for one of two sampled residents (Resident 1), prior to a facility-initiated room change for Resident 1 in accordance with the facility's policy and procedure on resident rights.This deficient practice had the potential to result in Resident 1's emotional distress or physical decline due to Resident 1 becoming unhappy with their living arrangements or developing distrust in the facility.Based on interview and record review, the facility failed to obtain informed consent and provide written notice for one of two sampled residents (Resident 1), prior to a facility-initiated room change for Resident 1 in accordance with the facility's policy and procedure on resident rights.This deficient practice had the potential to result in Resident 1's emotional distress or physical decline due to Resident 1 becoming unhappy with their living arrangements or developing distrust in the facility. Findings: During a review of Resident 1's History and Physical (H&P, a formal and complete assessment of the patient and the problem), dated 6/23/25, Resident 1's H&P indicated that Resident 1 had a past medical history of hypertension (HTN, high blood pressure), hyperlipidemia (high levels of fat in the blood), cardiomyopathy (a disease causing the heart muscle to become thick stiff, or enlarged, making it harder for the heart to pump blood to the body), and chronic back pain (persistent pain, stiffness, or discomfort in the back that lasts for more than three month) after a fall. Resident 1 was admitted for further physical therapy and rehab.During a concurrent interview and record review on 9/22/25 at 2:43 p.m. with the Nursing Director, the list of residents with room changes for the month of August and September was reviewed. The list did not indicate Resident 1 had a room change. ND stated that Resident 1 was moved on 6/26/25 from room A to room B to accommodate a male resident. Resident 1 was assigned to a room with another female resident. On 7/21/25, Resident 1 requested to be moved from room B to room D due to a confused resident across from room B. On 8/28/25, Resident 1 was moved to room C to accommodate a Federal Correctional Institute (FCI, inmate) resident that required continuous observation by two guards. On 8/29/25, Resident 1 requested to be moved from room C to room A to be closer to a patio exit door for easier access during smoke breaks (outdoor time accompanied by staff to allow smoking residents personal time for cigarettes). On 9/5/25, Resident 1 requested to move from room A and was placed in room E with two other female residents. ND stated that Resident 1 did not like room E and requested to return to room A.During a concurrent interview and record review on 9/22/25 at 3:27 p.m., the facility's Room Change Notification forms were reviewed. There were no forms for Resident 1's room changes. ND stated Resident 1 did not sign the room change notification form and that this was an identified gap which is being corrected. ND further stated this deviation in practice has been identified with immediate corrective actions taken.During an interview on 9/22/25 at 3:15 p.m. with Charge Nurse (CN) 1, CN 1 stated, when a room change is needed, if the resident is alert and oriented, the resident is asked permission for the room change with the reason for the change explained. If the resident is not (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: 056499 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 056499 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Providence Little CO of Mary Transitional Care Ctr 4320 Maricopa Street Torrance, CA 90503 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)