Health inspection·January 26, 2024

F 0626 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 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 readmit one of three sampled residents (Resident 1) from the general acute care hospital (GACH) after Resident 1 was cleared by the GACH to return to the facility on 1/25/2024. This resulted in the denial of Resident 1 ' s right to return to the facility. Finding: During a review of Resident 1 ' s admission Record (Face Sheet), the Face Sheet indicated Resident 1 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including diabetes (high blood sugar), muscle weakness (a lack of strength in the muscles), dysphagia (swallowing difficulties), chronic kidney disease ([CKD] a condition in which the kidneys are damaged and cannot filter blood), and heart failure (a condition when heart doesn ' t pump enough blood for body ' s needs). During a review of Resident 1 ' s History and Physical (H&P) dated 11/27/2023. The H& P indicated Resident 1 had the capacity to make medical decisions. During a review of Resident 1 ' s Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 11/29/2203, the MDS indicated Resident 1 was able to make self-understood and understand others. The MDS inidcated Resident 1's cognitiion was intact (ability to think and reason). The MDS inidcated Resident 1 required maximal assistance from staff for showering, grooming, bed mobility, and transfer. During a review of Resident 1 ' s Progress Note dated 12/17/2023 at 11 AM, the progress note indicated Resident 1 was admitted to the GACH due to acute kidney injury (when kidneys have stopped working well enough for you to survive), and pneumonia (an infection that effects one or both lungs). During a telephone interview on 1/26/2024 at 11:10 AM with the GACH Case Manager, the GACH CM stated the facility would not re-admit Resident 1 back to the facility because Resident 1 was positive for Candida auris (C. Auris, a type of fungus that grows as yeast that can cause severe illness and spreads easily among patients in healthcare facilities). The CM stated she was told by the facility ' s Director of Nursing (DON) Resident 1 could not return to the facility because of the isolation status. During an interview on 1/26/2024 at 12:57 PM with the DON, the DON stated the facility would not (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: 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 01/26/2024 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)