Health inspection·January 28, 2026

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 interview and medical record review, the facility failed to ensure the medical record was accurate for one of six sampled residents (Resident 1). * Resident 1's social services notes were not accurate related to the hours the resident went on a temporary out on pass from the facility. This failure had the potential to negatively impact the delivery of services as the medical information was not accurate.Findings: Medical record review for Resident 1 was initiated on 1/28/26. Resident 1 was admitted to the facility on [DATE]. Review of Resident 1's H&P examination dated 12/12/25, showed the resident could make needs known and make medical decisions. Review of Resident 1's Order Summary Report showed a physician's order dated 7/5/25, for the resident to may go out on pass for therapeutic purposes. Review of Resident 1's MDS assessment dated [DATE], showed Resident 1's had a BIMS score of 15, indicating resident was cognitively intact. Review of Resident 1's Release for Temporary Absence form (undated) showed the resident signed out for temporary absence from the facility on the following days:- on 11/3/25, the resident left the facility at 1400 to 1810 hours;- on 11/4/25, the resident left the facility at 1400 to 1750 hours;- on 11/5/25, the resident left the facility at 1415 to 1755 hours;- on 11/7/25, the resident left the facility at 1330 to 1830 hours;- on 11/8/25, the resident left the facility at 1330 to 1800 hours;- on 11/9/25, the resident left the facility at 1300 to 1710 hours;- on 11/10/25, the resident left the facility at 1315 hours, however, the return time was illegible;- on 11/11/25, the resident left the facility at 1345 hours, however, the return time was not documented;- on 11/12/25, the resident left the facility at 1400 hours, however the return time was not documented;- on 11/13/25, left facility at 1345 hours to 1810 hours;- on 11/14/25, the resident left the facility at 1300 hours to 1750 hours;- on 11/15/25, the resident left the facility at 1330 to 1740 hours;- on 11/16/25, the resident left the facility at 1300 hours to 1755 hours;- on 11/17/25, the resident left the facility at 1330 hours to 1800 hours;- on 11/18/25, the resident left the facility at 1330 hours, however, the return time was not documented;- on 11/19/25, the resident left the facility at 1400 hours, however, the return time was not documented;- on 11/20/25, the resident left the facility at 1330 hours to 1755 hours;- on 11/21/25, the resident left the facility at 1300 hours to 1810 hours;- on 11/22/25, the resident left the facility at 1300 hours to 1800 hours;- on 11/23/25, the resident left the facility at 1330 hours to 1805 hours;- on 11/24/25, the resident left the facility at 1330 hours to 1750 hours;- on 11/25/25, the resident left the facility at 1345 hours, however, the return time was not documented;- on 11/26/25, the resident left the facility at 1330 hours, however, the return time was not documented;- on 11/27/25, the resident left the facility at 1400 hours to 1810 hours;- on 11/28/25, the resident left the facility at 1400 hours to 1750 hours;- on 11/29/25, the resident left the facility at 1410 hours to 1745 hours;- on 11/30/25, the resident left the facility at 1410 hours, however, the return time was not documented;- on 12/1/25, the resident left the facility at 1400 hours to 1800 hours;(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 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 01/28/2026 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)