Health inspection·November 14, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the residents received services with reasonable accommodation of the resident needs for two of three sampled residents (Residents 2 and Resident 3). Resident 2 and Resident 3, who were at risk for falls, did not have the call light (an alerting device for residents to call for assistance) within the resident ' s reach. Residents Affected - Few This deficient practice had the potential for not meeting Residents 2 and 3's needs for assistance. Findings: During a record review of Resident 3 ' s admission Record, the admission Record indicated the facility admitted the resident on 7/10/2024 with diagnoses including metabolic encephalopathy (an alteration in consciousness due to brain dysfunction), essential hypertension (an abnormally high blood pressure that was not a result of a medical condition), type 2 diabetes mellitus (a chronic condition that affects the way the body processes blood sugar [glucose]). During a record review of Resident 3 ' s Minimum Data Set (MDS - a federally mandated resident assessment tool), dated 10/1/2024, the MDS indicated the resident ' s cognitive (mental action or process of acquiring knowledge and understanding) skills was severely impaired. During a record review of Resident 3 ' s Fall Risk Assessment, dated 10/27/2024, the Fall Risk Assessment indicated the resident had a total score of 12. A total score above 10 represented high risk for falls. During a record review of Resident 3 ' s Care Plan on falls, last revised on 10/27/2024, indicated the resident was high risk for falls. The Care Plan intervention indicated to be sure the resident ' s call light was within reach and encourage the resident to use it for assistance as needed. During an observation and concurrent interview on 11/14/2024 at 10:34 a.m. with the Assistant Director of Nursing (ADON), the ADON observed Resident 3 ' s call light hanging on the television (TV) rack located at the right head part of the resident ' s bed. The ADON stated Resident 3 ' s call light was not within the resident ' s reach. The ADON stated the residents used the call light to call nursing staff for assistance. The ADON stated Resident 3 ' s needs had the potential to not be met. The ADON stated Resident 3 had the potential to stand up unassisted, fall, and sustain an injury if the resident was unable to reach and use the call light to request nursing staff for assistance. The ADON stated the facility failed to ensure Resident 3 ' s call light was within the resident ' s reach. (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: 555012 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 555012 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/14/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley Village Care Center 13000 Victory Blvd 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)