Health inspection·March 26, 2024

F 0842 Level of Harm - Potential for minimal harm Residents Affected - Some Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility P&P review, the facility failed to ensure the medical records for two of three sampled residents (Resident 2 and 3) were complete and accurate. * The facility failed to ensure the complete documentation for Residents 2 and 3's turning and repositioning monitoring. This failure had the potential for the resident care needs not being met as the medical information was incomplete and inaccurate. Findings: Review of the facility's P&P titled Positioning and Repositioning Policy (undated) showed to assist the residents in positioning/repositioning every two hours and as needed, and the CNA will sign the Turn and Reposition every two hours or as needed in the CNA tasks to ensure that the positioning/repositioning task is performed on shift. a. Medical record review for Resident 2 was initiated on 3/25/24. Resident 2 was admitted to the facility on [DATE]. Review of Resident 2's Follow Up Question Report for March 2024 showed Resident 2 was turned and repositioned every two hours or as needed. The document further showed the missing documentation for turning and repositioning from the CNAs on the following shifts and dates: - afternoon shift on 3/4/24 - morning shift on 3/21/24 Review of Resident 2's Weekly Licensed Nurses Notes dated 3/25/24, failed to show the documentation if the repositioning every two hours or as indicated was provided to Resident 2. b. Medical record review for Resident 3 was initiated on 3/25/24. Resident 3 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 3's Follow Up Question Report for March 2024 showed Resident 3 was turned and repositioned every two hours or as needed. The document further showed no documented evidence of turning and repositioning from the CNA on the afternoon shift on 3/3/24. On 3/25/24 at 1532 hours, an interview and concurrent medical record review was conducted with the (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 3 Event ID: 555035 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 555035 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/26/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Anaheim Healthcare Center 3435 W Ball Road Anaheim, CA 92804 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)