Health inspection·January 14, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a care plan (a plan of care that summarizes a resident's health conditions, specific care needs, and current treatments) for one of three residents (Resident 2's) right hand swelling noted on 1/5/25. This failure had the potential to negatively affect the delivery of care and services. Findings: During a review of Resident 2's admission Record dated 1/14/25, it was indicated that Resident 2 was admitted to the facility on [DATE], with diagnoses including diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing), dementia (a progressive state of decline in mental abilities), muscle weakness, hypertension (high blood pressure), dysphagia (difficulty swallowing), abnormal posture, and Alzheimer's disease (a disease characterized by a progressive decline in mental abilities). During a review of Resident 2's History and Physical (H&P), dated 7/19/24 indicated the patient did not have the capacity (ability) to consent, the reason being dementia. During a review of Resident 2's Minimum Data Set (MDS-an assessment tool) dated 10/21/24 indicated the resident had severely impaired cognition (mental action of understanding, reasoning, thinking, judgment, thought) and required partial/moderate assistance (helper does less than half the effort) for eating, oral hygiene, and upper body dressing and bed mobility and required substantial/maximal assistance (helper does more than half the effort) for bed mobility, toileting, bathing/showering, lower body dressing, personal hygiene, and sit to stand. During a review of Resident 2's SBAR (Situation Background Assessment Recommendation) Communication Form and progress note dated 1/5/25 indicated Resident 2 had a change in condition of right-hand edema (swelling). During a concurrent interview and record review on 1/14/15 at 4:45 pm with the Director of Nursing (DON), Resident 2's care plans were reviewed. DON verified there was no care plan for the problem of right-hand edema in the resident's record and stated every problem had to have a care plan. During a review of the facility policy and procedures, Care Planning - Interdisciplinary Team reviewed 6/18/24, indicated the care plan is based on the resident's comprehensive assessment and is developed by a care planning/interdisciplinary team. Page 1 of 4 555019 555019 01/14/2025 Temple Park Convalescent Hospital 2411 W. Temple Street Los Angeles, CA 90026

F 0656 Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to develop and implement a care plan (a plan of care that summarizes a resident's health conditions, specific care needs, and current treatments) for one of three residents (Resident 2's) right hand swelling noted on 1/5/25. This failure had the potential to negatively affect the delivery of care and services. Residents Affected - Few Findings: During a review of Resident 2's admission Record dated 1/14/25, it was indicated that Resident 2 was admitted to the facility on [DATE], with diagnoses including diabetes mellitus (DM—a disorder characterized by difficulty in blood sugar control and poor wound healing), dementia (a progressive state of decline in mental abilities), muscle weakness, hypertension (high blood pressure), dysphagia (difficulty swallowing), abnormal posture, and Alzheimer's disease (a disease characterized by a progressive decline in mental abilities). During a review of Resident 2's History and Physical (H&P), dated 7/19/24 indicated the patient did not have the capacity (ability) to consent, the reason being dementia. During a review of Resident 2's Minimum Data Set (MDS—an assessment tool) dated 10/21/24 indicated the resident had severely impaired cognition (mental action of understanding, reasoning, thinking, judgment, thought) and required partial/moderate assistance (helper does less than half the effort) for eating, oral hygiene, and upper body dressing and bed mobility and required substantial/maximal assistance (helper does more than half the effort) for bed mobility, toileting, bathing/showering, lower body dressing, personal hygiene, and sit to stand. During a review of Resident 2's SBAR (Situation Background Assessment Recommendation) Communication Form and progress note dated 1/5/25 indicated Resident 2 had a change in condition of right-hand edema (swelling). During a concurrent interview and record review on 1/14/15 at 4:45 pm with the Director of Nursing (DON), Resident 2's care plans were reviewed. DON verified there was no care plan for the problem of right-hand edema in the resident's record and stated every problem had to have a care plan. During a review of the facility policy and procedures, Care Planning – Interdisciplinary Team reviewed 6/18/24, indicated the care plan is based on the resident's comprehensive assessment and is developed by a care planning/interdisciplinary team. 555019 Page 2 of 4 555019 01/14/2025 Temple Park Convalescent Hospital 2411 W. Temple Street Los Angeles, CA 90026

F 0692 Provide enough food/fluids to maintain a resident's health. 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 ensure one of three residents (Resident 2) was offered a substitute meal as required if the resident consumed less than 50% of the meal. Residents Affected - Few This deficient practice had the potential to result in malnutrition, dehydration, and overall decline in health and medical condition. Findings: During a review of Resident 2's admission Record dated 1/14/25, it was indicated that Resident 2 was admitted to the facility on [DATE], with diagnoses including diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing), dementia (a progressive state of decline in mental abilities), muscle weakness, hypertension (high blood pressure), dysphagia (difficulty swallowing), abnormal posture, and Alzheimer's disease (a disease characterized by a progressive decline in mental abilities). During a review of Resident 2's History and Physical (H&P), dated 7/19/24 indicated the patient does not have the capacity (ability) to consent, the reason being dementia. During a review of Resident 2's Minimum Data Set (MDS-an assessment tool) dated 10/21/24 indicated the resident had severely impaired cognition (mental action of understanding, reasoning, thinking, judgment, thought) and required partial/moderate assistance (helper does less than half the effort) for eating, oral hygiene, and upper body dressing and bed mobility and required substantial/maximal assistance (helper does more than half the effort) for bed mobility, toileting, bathing/showering, lower body dressing, personal hygiene, and sit to stand. During a concurrent interview and record review on 1/14/15 at 4:45 pm with the Director of Nursing (DON), Resident 2's CNA (Certified Nursing Assistant) Daily Charting Form dated January 2025 was reviewed. The record indicated; for breakfast on 1/4/25, 1/6/25, 1/7/25, 1/8/25, and 1/9/25, lunch on 1/1/25, 1/5/25, 1/6/25, 1/7/25, and 1/9/25, and dinner on 1/2/25 and 1/3/25, the resident's intake was documented as less than 50%, with no substitute offered. The DON verified these entries and stated they should have offered a substitute and documented it. During a review of the facility policy and procedures, Substitutions reviewed 6/18/24 indicated food substitutions will be made as appropriate or necessary. Based on interview and record review, the facility failed to ensure one of three residents (Resident 2) was offered a substitute meal as required if the resident consumed less than 50% of the meal. This deficient practice had the potential to result in malnutrition, dehydration, and overall decline in health and medical condition. Findings: During a review of Resident 2's admission Record dated 1/14/25, it was indicated that Resident 2 was admitted to the facility on [DATE], with diagnoses including diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing), dementia (a progressive 555019 Page 3 of 4 555019 01/14/2025 Temple Park Convalescent Hospital 2411 W. Temple Street Los Angeles, CA 90026

F 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few state of decline in mental abilities), muscle weakness, hypertension (high blood pressure), dysphagia (difficulty swallowing), abnormal posture, and Alzheimer's disease (a disease characterized by a progressive decline in mental abilities). During a review of Resident 2's History and Physical (H&P), dated 7/19/24 indicated the patient does not have the capacity (ability) to consent, the reason being dementia. During a review of Resident 2's Minimum Data Set (MDS-an assessment tool) dated 10/21/24 indicated the resident had severely impaired cognition (mental action of understanding, reasoning, thinking, judgment, thought) and required partial/moderate assistance (helper does less than half the effort) for eating, oral hygiene, and upper body dressing and bed mobility and required substantial/maximal assistance (helper does more than half the effort) for bed mobility, toileting, bathing/showering, lower body dressing, personal hygiene, and sit to stand. During a concurrent interview and record review on 1/14/15 at 4:45 pm with the Director of Nursing (DON), Resident 2's CNA (Certified Nursing Assistant) Daily Charting Form dated January 2025 was reviewed. The record indicated; for breakfast on 1/4/25, 1/6/25, 1/7/25, 1/8/25, and 1/9/25, lunch on 1/1/25, 1/5/25, 1/6/25, 1/7/25, and 1/9/25, and dinner on 1/2/25 and 1/3/25, the resident's intake was documented as less than 50%, with no substitute offered. The DON verified these entries and stated they should have offered a substitute and documented it. During a review of the facility policy and procedures, Substitutions reviewed 6/18/24 indicated food substitutions will be made as appropriate or necessary. 555019 Page 4 of 4