Health inspection·August 14, 2023

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure two of three sampled residents (Resident 1 and Resident 2) were allowed to return to the facility where they both had been living. Residents 1 and 2 were not provided the first available bed after Resident 1 and Resident 2 were cleared to return to the facility following their stay at a General Acute Care Hospital (GACH). This deficient practice resulted in Residents 1 and 2 being transferred to another facility and had the potential to negatively affect the resident ' s psychosocial well-being. Findings: During a review of Resident 1 ' s admission Record (Face Sheet), the Face Sheet indicated Resident 1 was originally admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses that included chronic obstructive pulmonary disease [(COPD], lung disease that causes blocked airflow from the lungs), Parkinson ' s disease (a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination) and chronic kidney disease ([CKD], condition which the kidneys are damaged and cannot filter blood as well as they should). During a review of Resident 1 ' s Minimum Data Set ([MDS] a standardized assessment and care screening tool) dated 5/21/2023, The MDS indicated Resident 1 was rarely/never understood and never/rarely made decisions. The MDS indicated Resident 1 was totally dependent on staff for toileting and needed extensive assistance for personal hygiene and dressing. During a review of Resident 1 ' s History and Physical (H&P), dated 6/17/2023, the H&P indicated Resident 1 did not have the capacity to understand and make decisions. During a review of Resident 1 ' s Change of Condition (COC) note dated 7/5/2023 at 11:10 p.m., the COC indicated Resident 1 was found to have shortness of breath, altered level of consciousness and a low oxygen saturation of 88% on room air. The COC indicated the paramedics were called and arrived at the bedside within minutes and Resident 1 was taken to GACH 1. The COC indicated Resident 1 ' s physician (MD1) ordered to transfer Resident 1 to GACH 1 and a bed hold (hold the resident ' s bed for 7 days). The Conservator was to be notified of the changes. During a review of Resident 1 ' s GACH inquiry packet, dated 8/2/2023, the GACH inquiry packet indicated the packet was sent to the facility on 8/2/2023. The GACH inquiry packet indicated Resident 1 was admitted to the GACH on 7/18/2023 and Resident 1 tested positive for C. auris on 6/14/2023. The GACH inquiry packet indicated Resident 1 ' s attending physician started discharge planning to 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: 555130 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 555130 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/14/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Maywood Skilled Nursing & Wellness Centre 6025 Pine Ave Maywood, CA 90270 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)