Health inspection·December 19, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to provide a safe and homelike environment by failing to provide room temperatures between 71 degrees Fahrenheit (°F - unit of measure) to 81 °F for seven of 38 sampled residents (Residents 1, 2, 3, 4, 5, 6, and 7). This deficient practice had the potential to result in uncomfortable temperatures related to cold weather compromising the health and safety of Residents 1, 2, 3, 4, 5, 6, and 7. Findings: During an observation on 12/19/2024 at 11:45 a.m., the Maintenance Director (MD) got room [ROOM NUMBER]'s temperature reading of 67.8 °F. During an observation on 12/19/2024 at 11:46 a.m., the MD got room [ROOM NUMBER]'s temperature reading of 65.1 °F. During an observation on 12/19/2024 at 11:47 a.m., the MD got room [ROOM NUMBER]'s temperature reading of 66 °F. During an observation on 12/19/2024 at 11:48 a.m., the MD got room [ROOM NUMBER]'s temperature reading of 68.5 °F. During an observation on 12/19/2024 at 11:49 a.m., the MD got room [ROOM NUMBER]'s temperature reading of 68.1 °F. During an observation on 12/19/2024 at 11:50 a.m., the MD got room [ROOM NUMBER]'s temperature reading of 70.3 °F. During an observation on 12/19/2024 at 11:51 a.m., the MD got room [ROOM NUMBER]'s temperature reading of 67.2 °F. During an observation on 12/19/2024 at 11:52 a.m., the MD got room [ROOM NUMBER]'s temperature reading of 69 °F. During an observation on 12/19/2024 at 11:53 a.m., the MD got room [ROOM NUMBER]'s temperature reading of 69 °F. (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: 555011 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 555011 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vineland Post Acute 10830 Oxnard Street North Hollywood, CA 91606 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)