Health inspection·May 7, 2025

F 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm **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 provide the necessary respiratory care and services for one of four sampled residents (Resident 4). Residents Affected - Few * The facility failed to ensure Resident 4's suction canister was changed. This failure had the potential to affect the respiratory health and well-being of the resident. Findings: Review of the facility's P&P titled Suction Canister Disposal dated July 2014 showed the suction canisters will be changed weekly, ¾ full, and PRN. Medical record review for Resident 4 was initiated on 5/7/25. Resident 4 was readmitted to the facility on [DATE]. Review of Resident 4's H&P examination dated 8/13/24, showed Resident 4 had the capacity to make and understand his own decision. Review of Resident 4's RT- Continuous Ventilator Flow Sheet dated 5/2/25 at 1800 hours, showed the suction canister was changed. On 5/7/25 at 1223 hours, Resident 4 was observed on the ventilator (medical device used to assist or take over the function of breathing) with the tubing connected to the suction canister which was full. On 5/7/25 at 1234 hours, an observation and concurrent interview was conducted with RT 1. When asked when Resident 4's suction canister was last changed, RT 1 stated the facility had scheduled to change the suction canister two times a week on Wednesdays, Saturdays, and PRN. RT 1 stated Resident 4's suction canister was last changed on 5/2/25 at 1800 hours. RT 1 further stated it would be changed today in the evening shift. When asked when the suction canister would be changed PRN, RT 1 stated when it was full. RT 1 verified the above findings and stated she was going to change the suction canister now. On 5/7/25 at 1310 hours, an interview and concurrent medical record review was conducted with the RT Supervisor. The RT Supervisor stated the suction canister should be changed when it was full. When asked what would happen if the suction canister was not changed when it was full, the RT Supervisor stated the equipment would not be able to suction and it was a potential for infection. The RT supervisor was informed and acknowledged Resident 4's suction canister should have been changed when it (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: 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 05/07/2025 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)