F 0755
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a
licensed pharmacist.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview, and facility P&P review, the facility failed to provide the necessary pharmaceutical
services for one of six sampled residents (Resident 2). * Resident 2 did not receive the medication as
ordered by the physician. This failure posed the risk of Resident 2 receiving unnecessary medication and
negative health consequences.Findings: Review of facility's P&P titled Medication Administration revised
12/19/22, showed the medications are administered by licensed nurses, or other staff who are legally
authorized to do so in this state, as ordered by the physician and in accordance with professional standards
of practice, with compliance guidelines to include: obtain and record vital signs, when applicable or per
physician orders. When applicable, hold medication for those vital signs outside the physician's prescribed
parameters. Medical record review for Resident 2 was initiated on 1/16/26. Resident 2 was admitted to the
facility on [DATE]. Review of Resident 2's H&P examination dated 8/22/25, showed Resident 2 with history
of Congestive Heart Failure and hypotension. Resident 2 had no capacity to make medical decisions.
Review of Resident 2's Order Summary Report showed an order dated 8/20/25, for Midodrine HCl
(medication to treat low blood pressure)10 mg tablet. Give one tablet via GT every eight hours for
hypotension, hold if SBP greater than 100 mmHg. Review of Resident 2's care plan for hypotension dated
9/4/25, showed to administer Midodrine HCl tablet for hypotension, monitor the vital signs and notify the MD
of significant abnormalities. Further review of Resident 2's MAR for January 2026 showed Resident 2 was
administered Midodrine 10 mg tablet on the following dates and times:- 1/2/26, BP 106/61 mmHg,
medication was administered at 0600 hours- 1/5/26, BP: 156/78 mmHg, medication was administered at
2200 hours- 1/7/26, BP: 102/60 mmHg, medication was administered at 1400 hours- 1/9/26, BP: 112/71
mmHg, medication was administered at 0600 hours and BP: 139/70 mmHg, medication was administered
at 2200 hours- 1/10/26, BP: 139/68 mmHg, medication was administered at 2200 hours- 1/11/26, BP:
124/76 mmHg, medication was administered at 0600 hours and BP: 136/70 mmHg, medication was
administered at 2200 hours- 1/13/26, BP: 127/64 mmHg, medication was administered at 2200 hours1/14/26, BP: 116/68 mmHg, medication was administered at 2200 hours- 1/15/26, BP: 106/66 mmHg,
medication was administered at 1400 hours and BP: 138/68 mmHg, medication was administered at 2200
hours- 1/16/26, BP: 126/72 mmHg, medication was administered at 0600 hours and BP: 108/66 mmHg,
medication was administered at 1400 hours On 1/16/26 at 1525 hours, an interview and concurrent medical
record review for Resident 2 was conducted with RN 1. RN 1 stated Resident 2 had an order for Midodrine
10 mg every eight hours for hypotension and to hold if the SBP was greater than 100 mmHg. RN 1 verified
the above findings and stated the medication should not have been administered on the above dates and
times. RN 1 further stated it could affect the resident's health. On 1/16/26 at 1645 hours, the Administrator
and Nursing Consultant were informed and acknowledged the findings.
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 2
Event ID:
555103
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
555103
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
01/16/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
French Park Care Center
600 E Washington Avenue
Santa Ana, CA 92701
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)
F 0850
Hire a qualified full-time social worker in a facility with more than 120 beds.
Level of Harm - Minimal harm
or potential for actual harm
Based on interview and facility document review, the facility failed to ensure the social worker was qualified
to fulfill the job responsibilities and role. * The facility social worker did not have a minimum of a bachelor's
degree in social work or a bachelor's degree in a human services field including but not limited to sociology,
gerontology, special education, rehabilitation counseling, and psychology. This failure has the potential to
jeopardize the health and well-being of 196 residents who required care and psychosocial needs in the
facility.Findings: Review of the facility's job description for Social Services Director (undated) showed all
facilities must provide medically-related social services to residents. Any facility with more than 120 beds
must employ a qualified social worker on a full-time basis. The social services department must be directed
by a qualified professional social worker who has a minimum of a bachelor's degree in social work or
another human services field to include, but not limited to, sociology, gerontology, special education,
rehabilitation counseling or psychology in addition to one year of supervised social work experience in a
health care setting. Review of the SSD's employee file (undated) showed the SSD's high school diploma as
the highest level of education in addition to previous SSD experience in another nursing facility. On 1/16/26
at 1105 hours, an interview was conducted with the SSD. The SSD stated she had been working as a
full-time SSD for two and a half years at the facility. The SSD verified her highest level of education
achievement was a high school diploma. On 1/16/26 at 1645 hours, the Administrator and Nursing
Consultant were informed and acknowledged the findings.
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
555103
If continuation sheet
Page 2 of 2