Health inspection·October 22, 2023

F 0641 Ensure each resident receives an accurate assessment. 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, two of seven sampled residents (Resident 3 and Resident 32), were assisted with nail hygiene and Resident 32 did not have a dry and scaly feet. Residents Affected - Some This deficient practice had the potential for Resident 3 and Resident 32 to scratch themselves, result in itchy skin and can result in skin breakdown. Findings: a. During a review of Resident 3's admission record, the admission record indicated Resident 3 was admitted on [DATE], with a diagnosis that included cognitive communication deficit (an impairment in organization/ thought organization, sequencing, attention, memory, planning, problem-solving, and safety awareness.), diabetes (abnormal blood sugar), and hypertension (high blood pressure) During a review of Resident 3's history and physical (H&P) dated 5/3/2023, the H&P indicated Resident 3 had the mental capacity to make needs known but cannot make medical decisions. During a review of Resident 3's minimum data set ([MDS] a standardized care assessment and care screening tool), dated 8/25/2023, the MDS indicated Resident 3's cognitive skills (thought process) was adequate and could understand and be understood by others. The MDS indicated Resident 3 required extensive assistance with activities of daily care such as dressing, toilet use, personal hygiene, transfer (moving between surfaces to and from bed, chair, and wheelchair) and bed mobility (how resident moves from lying to turning side to side). During a review of Resident 3's care plan for Activity of Daily Living (ADL) Functional, dated 8/25/2023, the care plan indicated impaired functional mobility as manifested by: Personal Hygiene, goal indicated grooming hygiene at sink with/without assistance, interventions indicated staff will provide grooming and hygiene. During an observation on 10/21/2023 at 4:19 p.m., in Resident 3's room. Resident 3 was sitting on a wheelchair next to her bed. Resident 3 had both hands nails untrimmed and dirty inside of nails. During an interview on 10/22/2023 at 2:36 p.m., with Certified Nursing Assistant (CNA) 1, CNA 1 stated, I assisted Resident 3 with daily care such as shower, change of clothes, diaper change, and making her bed. CNA 1 stated, Resident 3's hands nails are long and needs to cut the nails. CNA 1 stated, we must check the Resident 3 's hands nails during ADL care. CNA 1 stated, it is important to cut the hand nails to Resident 3, so she does not scratch herself or the nurses while proving care. Page 1 of 12 555040 555040 10/22/2023 Lotus Care Center 6011 West Blvd Los Angeles, CA 90043

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 10/22/2023 at 4:56 p.m., with Registered Nurses (RN)1, RN 1 stated the CNAs are responsible in checking the nails while providing ADL care and in trimming them (nails). RN 1 stated it is important to trim the hand nails for Resident 3's safety. RN 1 stated, Resident 3 can scratch herself and could potentially cause skin infections. b. During a review of Resident 32's admission record, the admission record indicated Resident 32 was admitted on [DATE], with a diagnosis that included vascular dementia (cognitive impairment/loss), other abnormalities of gait and mobility (a change to your walking pattern), and other symptoms and signs involving the musculoskeletal system (very common and may arise from joints, bones, muscles, ligaments, tendons, or bursas). During a review of Resident 32's H&P dated 9/8/2023, the H&P indicated Resident 32 had the mental capacity to make needs known but cannot make medical decisions. During a review of Resident 32's MDS, dated [DATE] the MDS indicated Resident 32's cognitive skills (thought process) was adequate and could understand and be understood by others. The MDS indicated Resident 32 required limited assistance with activities of daily care such as dressing, toilet use, personal hygiene, transfer and bed mobility. During a review of Resident 32's care plan for activity of daily living (ADL) Functional, dated 9/8/2023, the care plan indicated impaired functional mobility. One of the interventions indicated staff will provide grooming and hygiene. During a review of Resident 32's care plan dated 9/8/2023, indicated Resident 32 is at risk for skin breakdown related to: history of skin breakdown. The goal indicated Resident 32 will be free from signs and symptoms (s/s) of skin breakdown. One of the interventions indicated to check skin for s/s of breakdown such as redness, open areas daily during care, skin care every shift. During a concurrent observation and interview on 10/21/2023 at 2:17 p.m., in Residents 32's room. Resident 32 was observed sitting on his bed. Resident 32 had dryness on feet and hands. Resident 32 stated, I need some lotion on my legs for my dry skin. Resident 32 hands and feet nails untrimmed. Resident 32 stated, you can cut my nails. Resident 32 stated, I would like my nails to be cut. During an interview on 10/22/2023 at 4:48 p.m., with Resident 32, Resident 32 stated, today the nurse cut my nails on my both hands but not my feet. Resident 32 stated, I want nurse to cut my nails from my feet but not today, tomorrow. During an interview on 10/22/2023 at 4:48 p.m., CNA 2 stated, the CNAs are responsible in cutting residents hands nails. CNA 2 stated, the Podiatrists comes and cuts the nails on the feet. CNA 2 stated, when Resident 32's takes a shower, nurses must assist in putting lotion for the dryness on the skin. CNA 2 stated, they will notify the charge nurses if any issues with skin are found. CNA 2 stated the importance of applying lotion to Resident 32's feet is to keep the skin moist because dry skin can cause skin breakdown. CNA 2 stated, if Resident 32 had dryness in his feet, the nurses need to apply lotion. CNA 2 stated, Resident 32 can be at risk for a cracked skin and could lead to infection. During an interview on 10/22/2023 at 4:56 p.m., with Registered Nurses (RN) 1, RN 1 stated, the CNAs are responsible in assessing resident's hygiene while providing the ADL care and in trimming the nails if needed. RN 1 stated, if the hand nails are long, they should cut it. RN 1 stated it was 555040 Page 2 of 12 555040 10/22/2023 Lotus Care Center 6011 West Blvd Los Angeles, CA 90043

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some important to cut Resident 32's hand nails because Resident 2 could scratch himself and as well as the staff, it could prevent any potential skin infection and provide Resident 32 safety. RN 1 also stated, if CNA observed Resident 32 had dry skin during ADLs, the CNAs must apply body lotion to keep the skin moisturized. RN 1 also stated, it could prevent skin tears, or skin infection. During an interview on 10/22/2023 at 5:45 p.m., with Director of Nursing (DON), the DON stated, the CNAs are responsible in cutting the nails during the ADL care. If resident refused, they need to notify the DON or charge nurses. The DON stated, nurses need to trim residents' nails to prevent bacteria getting harbored under the nails, prevent the resident from scratching themselves and prevent skin injuries, and are important for Resident 3 and Resident 32's safety. DON stated, when CNAs see residents' dry skin, CNAs must apply lotion on the skin. The DON stated, if something major was observed during residents' care, the CNAs need to notify the charge nurses. The DON stated, CNAs can apply baby oil or lotion to keep the skin moist. If the skin is dry, it is more prone for skin tears, and itchy skin. The DON also stated, residents' skin and nails must be assessed daily while performing ADL care. During a review of the facility's policy and procedure titled, Nail Care, dated 4/2020, it indicated, All Residents shall provide with basic nursing care that includes good personal hygiene. Certified nursing assistance may provide hygiene services such as cutting of fingernails as directed by the licensed nurse. During a review of the facility's policy and procedure titled, Skin Care, dated 4/2020, it indicated to Inspect the skin on a daily basis when performing or assisting with personal care or ADL. Moisturize dry skin daily. Keep the skin clean and hydrated. 555040 Page 3 of 12 555040 10/22/2023 Lotus Care Center 6011 West Blvd Los Angeles, CA 90043

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the Preadmission Screening and Resident Review (PASRR, a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care) for two out of 17 sampled residents (Resident 28 and 22) Level 2 (a person-centered evaluation completed for anyone identified by the Level I Screening as having, or suspected of having, a PASRR condition, i.e serious mental illness, intellectual disability, developmental disability or related condition to determine whether placement or continued stay in a Nursing Facility is appropriate), were completed. Resident 28, who had a PASRR positive Level 1 (a preliminary assessment completed for all individuals prior to admission to a Medicaid-certified Nursing Facility in order to determine whether an individual might have a mental illness or intellectual disability), was not screened for Level 2 by a Level 2 contractor (by evaluators from The Department of Health Care Services or The Department of Developmental Services' Regional Centers). Resident 22, who was screened at the general acute hospital and had a PASRR positive Level 1, the facility did not follow up to ensure the Level 2 screening was completed. This deficient practice had the potential for the affected residents with mental illness to not having assessessed aprropriately and to not receive the appropriate care necessary to maintain the highest practicable physical, mental and psychosocial wellbeing. Findings A. During a review of Resident 28's admission Record, dated 10/9/2023, the admission Record indicated Resident 28 was originally admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including schizoaffective disorder (a mental health condition that can affect mood, thoughts, and behavior), paranoid schizophrenia (a pattern of behavior where a person feels distrustful and suspicious of other people and acts accordingly), and cognitive communication deficit (a deficit that results in difficulty with thinking and how someone uses language). During a review of Resident 28's History and Physical (H&P), dated 7/28/2023, the H&P indicated Resident 28 could make needs known but could not make medical decisions. During a review of Resident 28's Minimum Data Set ([MDS], a standardized assessment and care planning tool), dated 8/4/2023, the MDS indicated Resident 28 usually understands and was able to be understood by others. The MDS indicated Resident required extensive assistance from staff for dressing, limited assistance from staff for activities of daily living such as bed mobility, transferring (moving between surfaces to and from bed, chair, and wheelchair) , walking, locomotion, toileting, and personal hygiene, and supervision from staff for eating. During a review of Resident 28's Psychiatric follow up note, dated 9/7/2023, the Psychiatric follow up note indicated Resident 28 had a diagnosis of schizophrenia with hallucinations of talking to unseen person. During a review of Resident 28's PASRR (Preadmission Screening and Resident Review, a federal 555040 Page 4 of 12 555040 10/22/2023 Lotus Care Center 6011 West Blvd Los Angeles, CA 90043

F 0644 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care), Level 1 (a preliminary assessment completed for all individuals prior to admission to a Medicaid-certified Nursing Facility in order to determine whether an individual might have a mental illness or intellectual disability), dated 11/12/2021, the PASRR Level 1 indicated Resident 28 had a positive Level 1 screening that was positive for suspected mental illness (MI), which indicated a Level 2 (a person-centered evaluation completed for anyone identified by the Level I Screening as having, or suspected of having, a PASRR condition, i.e serious mental illness, intellectual disability, developmental disability or related condition to determine whether placement or continued stay in a Nursing Facility is appropriate) mental health evaluation was required. During a review of Resident 28's PASRR Level 2, dated 3/14/2022, it indicated the PASRR Level 2 evaluation indicated the Level 2 evaluation was not scheduled due to the resident being isolated as a health or safety precaution and the case was closed. During a concurrent interview and record review of Resident 28's PASRR Level 1 and Level 2, with the Director of Nursing (DON), on 10/22/2023 at 3:07 p.m., the DON stated she was responsible for overseeing PASRR in the facility. The DON stated Resident 28 had a positive PASRR Level 1 so a Level 2 was required. The DON stated the PASRR Level 2 was not done, and it was closed. The DON stated a new PASRR would have been done if the resident had a significant change of condition but Resident 28 did not have a significant change of condition. The DON stated, since Resident 28 did not have a significant change of condition, she never sent out another PASRR and because of that, Resident 28 was not assessed for appropriateness of placement when Resident 28 should have been assessed. B. During a review of Resident 22's admission record, the admission record indicated Resident 22 was admitted on [DATE], with a diagnosis that included Paranoid schizoaffective disorder (mental illness that can affect your thoughts, mood and behavior.), anxiety disorder (persistent and excessive worry that interferes with daily activities) and depressive disorder (A mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.) During a review of Resident 22's history and physical (H&P) dated 8/4/2023, the H&P indicated Resident 22 has the capacity to understand and make medical decisions. During a review of Resident 22's MDS, dated [DATE], the MDS indicated Resident 22's cognitive skills (thought process) was adequate and could understand and be understood by others. The MDS indicated Resident 22 required extensive assistance with activities such as dressing, toilet use, personal hygiene, limited assistance while transfer and bed mobility. During a review of Resident 22's PASRR Level 1 screening dated on 7/27/2023, indicated that Resident 22's Level 1 screening was positive for suspected MI (Mental Illness). During a review of Resident 22's chart on 10/21/2023 at 2:26 p.m., it did not indicate a PASRR level II screening was completed by a Level 2 contractor nor any documentations from the Level 2 contractor that the case was closed. During an interview and record review on 10/21/2023 at 2:26 p.m. with Director of Nursing (DON), the DON stated, PASRR level 1 was screened at the hospital prior to admission. DON stated upon admission, all residents are screened for PASRR level I. DON stated, Resident 22 was admitted to this facility on 8/1/2023, and on admission, Resident 22 had PASRR level 1. DON stated, I oversee following up 555040 Page 5 of 12 555040 10/22/2023 Lotus Care Center 6011 West Blvd Los Angeles, CA 90043

F 0644 Level of Harm - Minimal harm or potential for actual harm for PASRR level II, however, Resident 22's chart did not indicate the PASRR Level 2 was done. DON stated, when Resident 22 was screened at the general acute hospital (hospital) for PASRR level 1, the facility should have called the hospital and find out if Resident 22 was screened for PASRR level 2. The DON stated, the importance of getting Resident 22's PASRR level 1 was to determine if Resident 22 is appropriate to be at the facility, so Resident 22 will receive the proper care for MI diagnosis. Residents Affected - Few During a review of the facility's policy and procedure (P&P) titled, Preadmission Screening and Resident Review (PASRR), dated 8/2023, it indicated that When an individual is being admitted to a SNF from a Hospital, the SNF must not submit a new Level I Screening and must instead confirm that the PASRR process was completed by the Hospital. It also indicated, in instances of positive Level 1 screenings, the Level 2 contractor will call the SNF to confirm the information on the Level 1 screening and determine if a Level 2 evaluation is needed. As part of the Initial Assessment process, the Level 2 contractor would make two attempts in 48 hours and to confirm a positive Level I Screening and request medical records from the SNF. SNFs must participate in the initial assessment process within 24 hours of submitting the completed Level 1 screening or upon request of the Level 2 contractor. SNFs must coordinate with the Level II Contractor to ensure the PASRR process is completed before admitting the individual to their facility. If the Level II Contractor is unable to complete the Initial Assessment process because the SNF is nonresponsive or does not provide the required documentation timely (within 14 hours), the Level II Contractor will close the case as an Attempt or Unavailable. A PASRR case closed as an Attempt or Unavailable due to the facility not providing the required documentation to the Level II Contractor does not complete the PASRR process and the SNF will be required to restart the PASRR process by completing a new Level I Screening. 555040 Page 6 of 12 555040 10/22/2023 Lotus Care Center 6011 West Blvd Los Angeles, CA 90043

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, interviews, and record reviews, the facility failed to to ensure hygiene products that were stored in the facility's central supply room were not expired. This deficient practice had the potential for the products to lose its effectiveness and strength and can result to a skin reaction or any adverse reactions to the residents. Findings: During an observation on [DATE] at 8:10 a.m. of the central supply room, 20 bottles of baby powder had an expiration date of [DATE], 48 morning fresh (brand) toothpaste tubes had an expiration date of 9/2023, two (2) boxes of denture cleaner had an expiration date of 9/2023 and 30 bottles of mouth wash had an expiration date of [DATE]. During an interview on [DATE] at 5:32 p.m., with Registered Nurse (RN) 1, RN 1 stated, the central supply room contained all hygiene products the resident needed for their activities of daily care (ADLS, maintaining a safe environment, communication, breathing, eating, and drinking, elimination, washing and dressing] such as, toothpaste, lotions, mouth wash, oils, powder. RN 1 stated, when residents needed any of the supplies, nurses must check the expiration date first before it is used or applied to the residents. RN 1 stated the importance of checking the expiration date is for residents' safety. RN 1 stated, the risk of residents receiving expired products in their mouth or skin can developed an adverse reaction to the products, or causes skin irritation. During an interview on [DATE] at 6:00 pm., with Director of Nursing (DON), the DON stated, nursing oversees the central supply room. When the new shipment arrived, the products are usually stored in the shelves. The DON stated, the nurses need to monitor the expiration date of the hygiene products before giving them to the residents to make sure of their effectiveness, preventing any bad reactions, any skin irritations, any gums disease and preventing any injuries related to an expired product. During a review of the facility's policies and procedures (P&P) titled Receipt and storage of Supplies and Equipment, dated 12/2016 the P&P indicated All supplies and equipment must be stored in accordance with the manufacturer's recommendations. It shall be the purchasing agent's responsibility to assure that proper storage procedures are maintained. 555040 Page 7 of 12 555040 10/22/2023 Lotus Care Center 6011 West Blvd Los Angeles, CA 90043

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review, the facility failed to ensure food products stored in the freezer were labeled use by dates (last date recommended for the use of the product while at peak quality) as per the facility's policy and procedure. This deficient practice can affect the palatability (taste) of the food prepared and had the potential to place the residents at risk for food borne illnesses. Findings During an observation on 10/21/2023 at 7:44 a.m. in the kitchen, three bags of hash browns and three bags of tater tots (shaped diced potatoes for cooking) were in the freezer and had no label when the bags were received and had no use by (last date recommended for the use of the product while at peak quality) dates. During an interview with the kitchen manager (KM) on 10/21/2023 at 7:50 a.m., the KM stated the bags of hash browns and tater tots were not expired but the bags did not have a blue label indicating when the bags were received and when to use the bags by. During another interview with the KM on 10/22/2023 at 1:26 p.m., the KM stated when food arrives to the facility, the food must be labeled with the date received. The KM stated the food needed to be labeled so the staff would know which products to use first and to make sure the food was not expired. The KM stated if food was not labeled, the food could be in the freezer for a long time, could be expired, and the food could lose their nutrition, texture, and flavor. If the staff served the expired food, the residents could get sick. During an interview with the Director of Nursing (DON) on 10/22/2023 at 5:38 p.m., the DON stated when storing all products, the products must be labeled with the opened date and the expiration date. During a review of the facility's policy and procedure (P&P) titled, Refrigerators and Freezers, dated 12/2014, it indicated that all food should be appropriately dated to ensure proper rotation by expiration dates; received dates would be marked on cases and on individual items removed from cases for storage and the expiration date should be on unopened food and the use by date should be on opened food. During a review of the facility's P&P titled, Food Receiving and Storage, dated 7/2014, the P&P indicated all foods stored in the refrigerator or freezer would be covered, labeled, and dated. 555040 Page 8 of 12 555040 10/22/2023 Lotus Care Center 6011 West Blvd Los Angeles, CA 90043

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. Based on observation, interview, and record review, the facility failed to meet the required 80 square feet per resident in a multiple resident bedrooms (Rooms 1, 6, 7, 8, 9, 11, 12, 14, 15, 16 and 17) and 100 square feet per resident in single resident rooms (Rooms 2, 3, 4, 5, 10). This deficient practice had the reduced required space for each resident which had the potential for inadequate space during resident care, and or the inability for resident access, use of personal assistive devices, furniture, and enough space for the visitors. Findings: During a concurrent observation of the resident rooms and interview with the Maintenance Supervisor (MS) on 10/22/2023 at 7:44 a.m., the MS stated several of the bedrooms were smaller than required. During a review of the facility's Client Accommodations Analysis form, the form indicated the following resident bedrooms measurements: Room Numbers Number of Beds Total Square feet 1 2 125.28 2, 3, 4, 5 1 97.51 6 2 138.88 7 2 156.75 555040 Page 9 of 12 555040 10/22/2023 Lotus Care Center 6011 West Blvd Los Angeles, CA 90043

F 0912 8 Level of Harm - Potential for minimal harm 2 156.75 Residents Affected - Some 9 2 141.36 10 2 160.31 11 4 290.67 12, 14, 15 ,16, 17 4 295.32 During a review of the waiver request letter dated 3/8/2023, submitted by the Administrator (ADM), the request indicated the following room measurements: Room No. No. of Beds Dimensions Total feet Square footage for each resident 1 2 13.92 ft x 9 ft 555040 Page 10 of 12 555040 10/22/2023 Lotus Care Center 6011 West Blvd Los Angeles, CA 90043

F 0912 125.28 Level of Harm - Potential for minimal harm 62.64 2, 3, 4, 5 Residents Affected - Some 1 9.92 ft x 9.83 ft 97.51 97.51 6 2 9.92 ft x14 ft 138.88 69.44 7 2 11 ft x 14.25 ft 156.75 78.38 8 2 11 ft x 14.25 ft 156.75 78.38 9 2 9.92 ft x14.25 ft 555040 Page 11 of 12 555040 10/22/2023 Lotus Care Center 6011 West Blvd Los Angeles, CA 90043

F 0912 141.36 Level of Harm - Potential for minimal harm 70.68 10 Residents Affected - Some 2 11 ft x 14.25 ft 160.31 80.16 11 4 27.1 x 10.7 ft 290.67 72.67 12, 13, 14, 4 27.6 x 10.7 ft 295.32 73.83 15, 16, 17 The letter indicated resident rooms 2, 3, 4, 5 and 10, measured more than the required 80 square feet per resident. The letter also indicated there was enough space for each resident's care and there was no negative outcome with regards to the health, safety, and welfare to all the residents in the facility. The Department is recommending a waiver. 555040 Page 12 of 12