Health inspection·November 9, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure fall preventive measures were implemented for one of four sampled residents (Resident 37). Resident 37's bed was not positioned at the lowest position. This deficient practice had the potential for injury, accidents or fall to Resident 37. Findings: During a review of Resident 37's admission Record, the admission record indicated the facility readmitted the resident in 2/6/23, with diagnoses that included cerebral infarction (type of ischemic [deficient supply of blood] stroke [sudden death of brain cells in a localized area due to inadequate blood flow] resulting from a blockage in the blood vessels supplying blood to the brain). During a review of Resident 37's Minimum Data Set (MDS - a standardized assessment and care planning tool) dated 8/25/23, the MDS indicated the resident had moderate impaired cognition (ability to understand). The MDS indicated Resident 37 required extensive assistance (resident involved in activity, staff provide weight-bearing support) with transfer, dressing, toilet use and personal hygiene. During a review of Resident 37's Fall Risk assessment dated [DATE], the fall risk assessment indicated the resident was assessed as high risk for falls due to intermittent confusion, gait and balance problems and predisposing medical conditions. During a review of Resident 37's care plan titled, Fall Risk revised on 11/2023, the care plan interventions indicated to keep the resident's environment free of slip/trip and fall hazards. During an observation on 11/7/23 at 2:40 p.m., Resident 37 was sleeping on the bed with the height of the bed positioned 79 inches off the floor. Certified Nursing Assistant 1 (CNA 1) lowered the bed to the lowest position and the top of the bed measured 53 inches off the floor. CNA 1 stated, CNA 1 was not aware if Resident 37 was high risk for falls. CNA 1 stated Resident 37 could be at risk for falls since the resident had fall mats in place. CNA 1 stated moving the bed at the lowest position could help prevent severe injuries if Resident 37 would have a fall. During an observation on 11/8/23 at 11:22 a.m., Resident 37 was sleeping on the bed with the height of the bed positioned 68 inches off the floor. CNA 2 lowered the bed to the lowest position possible and the top of the bed measured 53 inches off the floor. CNA 2 stated, CNA 2 was not assigned to Resident 37 but stated the resident's bed needed to be positioned low to prevent severe injuries if Page 1 of 14 555199 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

F 0689 the resident would have a fall. Level of Harm - Minimal harm or potential for actual harm During a concurrent record review of Resident 37's Fall Risk Assessment and interview with the Medical Records Director (MRD) on 11/09/23 at 10:52 a.m., MRD stated based on the Fall Risk Assessment, Resident 37 was assessed as high risk for falls. Residents Affected - Few During a review of the facility's undated Policy and Procedure (P&P) titled Falls and Fall Risk, Managing, the P&P indicated staff will identify and implement relevant interventions to try to minimize serious consequences of falling. 555199 Page 2 of 14 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube. Based on observation, interview, and record review, the facility failed to ensure gastrostomy (a tube inserted through the abdomen wall and into the stomach used for feeding or drainage) tube feeding was provided in accordance with the physician's order, for one of one sampled resident (Resident 41). This deficient practice had the potential to result in weight loss for Resident 41. Findings: During a review of Resident 41's admission Record, the admission record indicated the facility readmitted the resident on 4/8/22, with diagnoses that included cerebral infarction (stroke) and gastrostomy. During a review of Resident 41's care plan titled, Gastrostomy Tube Feeding dated 4/8/22, the care plan interventions included to provide gastrostomy feeding as ordered. During a review of Resident 41's Minimum Data Set (MDS - a standardized assessment and care planning tool) dated 10/13/23, the MDS indicated the resident was not able to express ideas and sometimes understand others. The MDS indicated Resident 41 was dependent in all activities of daily living including eating, oral hygiene, toileting, and personal hygiene. The MDS indicated Resident 41 was on tube feeding. During a review of Resident 41's recapped Physician Orders for November 2023 indicated, the physician order indicated gastrostomy tube feeding of Isosource HN (a nutritionally complete tube feeding formula) 1.5 at 50 milliliters (ml- unit of measurement) per hour for 20 hours via enteral feeding pump for 20 hours to provide 1000 ml. per day and to start the feeding at 2 p.m. until dose is fed. During an observation on 11/9/23 at 8:14 a.m., Resident 41 was in bed, the head of bed (HOB) was raised at 30 degrees and the resident's tube feeding (TF) pump was off. During an observation on 11/9/23 at 9:03 a.m., Resident 41 was in bed, the head of bed (HOB) was raised at 30 degrees and the resident's tube feeding (TF) pump was off. During an observation on 11/9/23 09:57 a.m., Resident 41 was in bed, the head of bed (HOB) was raised at 30 degrees and the resident's TF of Isosource was running at 50 ml. per hour through the TF pump. During an interview on 11/9/23 with Licensed Vocational Nurse 2 (LVN 2) on 11/9/23 at 10 a.m., LVN 2 stated she did not know the TF was off, she was still administering medications to other residents and had not been to Resident 41's room yet. During an interview on 11/9/23 at 10:03 a.m., LVN 2 stated she turned on Resident 41's TF pump around 9:30 am because she saw it was off. LVN 2 stated, certified nursing assistants needed to let the licensed nurses know when they were done changing the resident. LVN 2 stated there was no report to hold the TF for Resident 41. LVN 2 stated when Resident 41's TF was off longer than 30 minutes, Resident 41 could not get the full dose of the TF as ordered. LVN 2 checked the TF pump and stated 860 555199 Page 3 of 14 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

F 0693 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few ml of tube feeding was delivered and the licensed nurses would turn off the TF when the maximum order was reached. During a review of the facility's undated Policy and Procedure titled Enteral Nutrition, the P&P indicated feeding pump should be monitored to ensure feeding pump is infusing the correct amount of formula as prescribed by the physician. 555199 Page 4 of 14 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

F 0700 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to attempt the use of alternatives to bed rails before its installation, for three of four sampled residents (Residents 11, 33 and 37). These deficient practices placed Residents 11, 33 and 37 at risk for entrapment and injury from the use of bed rails. Findings: 1. During a review of Resident 11's admission Record, the record indicated the resident was readmitted to the facility on [DATE], with diagnoses that included diabetes mellitus (a chronic disease that occurs when the pancreas [an organ located in the abdomen] does not produce enough insulin [hormone that regulates blood sugar] or when the body cannot effectively use the insulin it produces) and Chronic Obstructive Pulmonary Disease ([COPD] a group of lung diseases that block airflow and make it difficult to breathe). During a concurrent observation and interview with Resident 11 on 11/7/23 at 9:30 a.m., Resident 11 was lying on her back in bed with half- length bed rails up on both sides. Resident 11 stated her bed rails were always raised since admission to the facility. The resident stated she did not know why her bed rails on both sides were up. During a concurrent record review and interview with Licensed Vocational Nurse (LVN 1) on 11/8/23 at 2:23 p.m., LVN 1 stated Resident 11's half -length bed rails were always raised for the resident to grab the bed rails when staff was turning and repositioning the resident in bed. LVN 1 stated the use of bed rails were an accident hazard because Resident 11 was at risk for serious injury and/or death due to entrapment from the bed rails. LVN 1 stated he did not know appropriate alternatives were to be used before installing the bed rails for Resident 11. LVN 1 also stated Resident 11's medical record did not have documented evidence that appropriate alternatives were used for Resident 11 before the bed rails were applied. 2. During a review of Resident 33's admission Record, the record indicated the resident was readmitted to the facility on [DATE], with diagnoses that included diabetes mellitus and dementia (a group of conditions characterized by impairment of memory and judgment). During observations on 11/7/23 at 9:20 a.m. and 11/8/23 at 10 a.m., Resident 33 was observed awake in bed and confused. Resident 33's half-length bed rails were up on both sides. During a concurrent record review and interview with the DON on 11/8/23 at 2:20 p.m. the facility's undated Policy and Procedure (P&P) titled, Bed Safety was reviewed. The P&P indicated the facility will strive to prevent /reduce hazards such as resident entrapment associated with hospital beds. The P&P did not indicate the use of appropriate alternatives to bed rails. The DON stated Resident 33's medical record did not have documentation of appropriate alternatives used before the bed rails were applied for Resident 33. The DON stated he thought bed rails could be installed as an enabler for resident's mobility without attempting the use of appropriate alternatives to bed rails. The DON stated the use of bed rails could cause serious injury and/or death due to entrapment of resident's 555199 Page 5 of 14 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

F 0700 head or limb in between the gap of the bed rails. Level of Harm - Minimal harm or potential for actual harm 3. During a review of Resident 37's admission Record, the admission record indicated the facility readmitted the resident in 2/6/23, with diagnoses that included cerebral infarction (type of ischemic [deficient supply of blood] stroke [sudden death of brain cells in a localized area due to inadequate blood flow] resulting from a blockage in the blood vessels supplying blood to the brain). Residents Affected - Some During a review of Resident 37's Minimum Data Set (MDS - a standardized assessment and care planning tool) dated 8/25/23, the MDS indicated the resident had moderate impaired cognition (ability to understand). The MDS indicated Resident 37 required extensive assistance (resident involved in activity, staff provide weight-bearing support) with transfer, dressing, toilet use and personal hygiene. During an observation on 11/7/23 at 9:20 a.m., Resident 37 was awake, lying on an air mattress bed (specialized sleep surface for skin management) with bilateral (both sides) padded upper bed rails up and fall mats on both sides of the bed. During an interview on 11/08/23 at 4:41 p.m., Registered Nurse 1 (RN 1) stated bilateral side rails were applied to Resident 37 as an enabler. RN 1 stated Resident 1 was not able to get out of bed by herself. RN 1 stated appropriate alternatives were not attempted prior to application of the bed rails. RN 1 stated appropriate alternatives included bolsters, pillows and non-skid pads. During a concurrent review of the document titled Siderail Assessment and interview with the facility's Director of Nursing (DON) on 11/8/23 at 4:54 p.m., the DON stated appropriate alternatives were not attempted prior to the use of bed rails for Resident 37. During a review of the facility's undated Policy and Procedure (P&P) titled, Bed Safety, the P&P indicated the facility will strive to prevent /reduce hazards such as resident entrapment associated with hospital beds. The P&P did not indicate the use of appropriate alternatives to bed rails. 555199 Page 6 of 14 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

F 0726 Level of Harm - Minimal harm or potential for actual harm Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. Based on interview and record review, the facility failed to conduct staff competency for three of three facility staff. Residents Affected - Few This deficient practice had the potential to affect resident care. Findings: During a review of the facility's staff competency on 11/9/23 at 3:55 p.m., the facility's staff competency indicated the following: a. Certified Nursing Assistant 3 had no annual competency skills assessment. b. Restorative Nursing Assistant 1 had competency assessment completed on 9/14/23. c. Certified Nursing Assistant 4 had no annual competency assessment. During an interview with the Director of Staff Development (DSD) on 11/9/23 at 4:02 p.m., the DSD confirmed the above finding and stated competency assessments were to be completed upon hire, annually and as needed when there were reports of the staff not being competent with job specific skills. During a review of the facility's undated Policy and Procedure titled Performance Evaluation, the P&P indicated employees shall be evaluated initially at the end of their 90-day probationary period, and once in every year and as necessary depending on the nature and demands of the job. 555199 Page 7 of 14 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure three of five sampled residents (Residents 11,17 and 42) on psychotropic drugs (any drug capable of affecting the mood, emotions, and behavior) were free from unnecessary medication by failing to: 1. Attempt a Gradual Dose Reduction (GDR- tapering of a dose) of Aripiprazole ([antipsychotic drug] drug use to treat psychosis [severe mental disorders that cause abnormal thinking and perceptions]) 30 milligrams (mg-unit of measurement) for Resident 17. 2. Attempt GDR of Temazepam 15 mg ([sedative-hypnotic drug] a class of drugs used to induce and/or maintain sleep) for Resident 11. 3. Ensure Ativan was ordered to treat a specific condition documented in the clinical record for Resident 42. 4. Ensure Ativan was administered to treat a specific behavior for Resident 42. These deficient practices placed Residents 11, 17 and 42 at risk for adverse drug reaction. Findings: 1. During a review of Resident 17's admission Record, the record indicated the resident was readmitted to the facility on [DATE] with diagnoses that included diabetes mellitus (chronic disease that occurs when the pancreas [an organ located in the abdomen] does not produce enough insulin [hormone that regulates blood sugar] or when the body cannot effectively use the insulin it produces), dementia (a group of conditions characterized by impairment of memory and judgment) and schizophrenia (a disorder that affects a person's ability to think, feel, and behave clearly.) During a review of Resident 17's Physician Order dated 8/28/23, the physician's order indicated the resident was readmitted with an order to give Resident 17 Aripiprazole 30 mg one tablet by mouth every day for schizophrenia as manifested by disorganize speech and disorganize behavior/inappropriate behavior of hoarding and putting different objects inside his adult brief and his pocket. During a review of Resident 17's Medication Administration Record (MAR) dated 11/01/23- 11/08/23, the MAR indicated Resident 17 received Aripiprazole 30 mg one tablet every day for inappropriate behavior of hoarding and putting different objects inside his diaper and his pocket. During a concurrent observation and interview on 11/8/23 at 11:32 a.m. with Resident 17, the resident was wearing sweatpants, ambulatory (ability to walk) in his room, alert and coherent. Resident 17 showed both pockets of his sweatpants contained two pieces of clean facial tissue paper. Resident 17 stated he stocked the clean facial tissue paper in his pockets to use it just in case blood came out when he sneezes and/or blow his nose because he had leukemia (cancer of the blood caused by a rise in the number of white blood cells in the body) long time ago. Resident 17 showed his bed side drawer contained several pieces of clean adult briefs. Resident 17 stated he kept the clean adult briefs in the drawer to change himself because he frequently urinates due to diabetes mellitus. Resident 555199 Page 8 of 14 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 17 stated, I do it myself to change diaper. Resident 17 stated he does not put things in his diaper because it would hurt his buttocks. During a concurrent record review and interview with Licensed Vocational Nurse (LVN 1) on 11/8/23 at 11:40 a.m., LVN 1 stated there was no documentation in Resident 17's medical record that GDR of Aripiprazole would be clinically contraindicated and there was no history of past failed attempt of GDR. LVN 1 stated Resident 17's hoarding of clean tissue paper in his pocket and clean diapers in his drawer were not an adequate indication for the continuous use of Aripiprazole because the resident's behavior of hoarding would not cause an immediate harm to the resident or others. LVN 1 stated Resident 17 was forgetful due to dementia and the target symptom of resident's hoarding could also be managed using nondrug interventions to prevent the adverse drug reaction from the use of an antipsychotic drug. 2. During a review of Resident 11's admission Record, the record indicated the resident was readmitted to the facility on [DATE] with diagnoses that included diabetes mellitus and Chronic Obstructive Pulmonary Disease ([COPD] a group of lung diseases that block airflow and make it difficult to breathe). During a review of Resident 11's Physician Order dated 6/23/23, the physician's order indicated the resident was admitted with an order to give Temazepam 15 milligram (mg) one capsule by mouth every bed time for insomnia (difficulty of sleeping) as manifested by stating that she cannot fall asleep. During a review of Resident 11 MAR dated 11/1/23-11/8/23, the MAR indicated Resident 11 received Temazepam 15 mg one capsule by mouth every bed time for insomnia. The MAR further indicated Resident 11 slept an average total of eight hours per day. During a review of Resident 11's Consultant Pharmacist Medication Regimen Review (MRR) dated 10/16/23, the MRR indicated a written recommendation from the Consultant Pharmacist to Resident 11's Physician to attempt a gradual dose reduction of Temazepam 15 mg by decreasing the dose to Temazepam 7.5 mg every bed time or Temazepam 15 mg every other night for Resident 11. During a concurrent record review and interview with the Director of Nursing (DON) on 11/9/23 at 9:15 a.m., Resident 11's Psychiatrist written response to Consultant Pharmacist dated 10/16/23 was reviewed. The psychiatrist written response indicated the resident's psychiatrist checked off the disagree box that GDR was declined for Temazepam and the psychiatrist did not document the clinical rationale for not attempting GDR per Pharmacist recommendation. The DON stated there was no documented evidence in Resident 11's medical record of clinical rationale that GDR of Temazepam would be clinically contraindicated and there was no history of past failed attempt to decrease the dose of Temazepam since ordered on 6/23/23. During a review of the facility's Policy and Procedures (P&P) dated 5/2022 titled, Psychotropic and Psychotherapeutic Drugs the P&P indicated the need for psychotherapeutic drug shall be periodically evaluated, no less than quarterly, and attempts shall be made for gradual dose reduction. 3. During a review of Resident 42's admission Record, the admission record indicated the facility admitted the resident on 8/30/23 with diagnoses that included dementia (the loss of cognitive functioning such as thinking, remembering, and reasoning that interferes with a person's daily life and activities,) and Alzheimer's disease (irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks). 555199 Page 9 of 14 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

F 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a review of Resident 42's Minimum Data Set (MDS- a standardized assessment and care planning tool) dated 9/5/23, the MDS indicated the resident had moderately impaired cognition (ability to understand), able to express ideas and wants and able to understand verbal content. The MDS indicated Resident 42 required extensive assistance (resident involved in activity, staff provide weight bearing support) with bed mobility, transfers, locomotion (how resident moves between locations,) dressing, toilet use and personal hygiene. During a review of Resident 42's recapped Physician Orders for November 2023, the physician's order dated 11/6/23 indicated for Resident 42 to receive Ativan (medication to treat anxiety) 0.5 milligrams (mg-unit of measurement) by mouth every 6 hours as needed for anxiety disorder for 14 days, manifested by restlessness, then re assess on 11/20/23. During a concurrent review of the physician orders and interview with Registered Nurse 1 (RN1) on 11/9/23 at 2:12 p.m., RN 1 stated restlessness was not a specific target behavior. RN 1 stated if the target behavior was not specific, this would be interpreted in different ways and Ativan could be administered to Resident 42 for reasons other than the target behavior. During a concurrent review of the physician's order and interview with Licensed Vocational Nurse 3 (LVN 3) on 11/9/23 at 2:30 p.m., LVN 3 stated restlessness was not a specific target behavior and could mean when Resident 42 was in bed and wanted to get up. During a review of the facility's undated Policy and Procedure (P&P) titled Psychotropic and Psychotherapeutic drugs, the P&P indicated the facility shall use a psychotherapeutic drug or psychotropic drug only on the written order of a physician that specifies the duration of the use of the medication and the circumstances under which medication is to be used (health record must contain a diagnosis and specific behavior manifestations for which the medication is being used. 4. During a review of Resident 42's admission Record, the admission record indicated the facility admitted the resident on 8/30/23 with diagnoses that included dementia (the loss of cognitive functioning such as thinking, remembering, and reasoning that interferes with a person's daily life and activities,) and Alzheimer's disease (irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks). During a review of Resident 42's Minimum Data Set (MDS- a standardized assessment and care planning tool) dated 9/5/23, the MDS indicated the resident had moderately impaired cognition (ability to understand), able to express ideas and wants and able to understand verbal content. The MDS indicated Resident 42 required extensive assistance (resident involved in activity, staff provide weight bearing support) with bed mobility, transfers, locomotion (how resident moves between locations,) dressing, toilet use and personal hygiene. During a review of Resident 42's recapped Physician Orders for November 2023, the physician's order dated 11/6/23 indicated for Resident 42 to receive Ativan (medication to treat anxiety) 0.5 milligrams (mg-unit of measurement) by mouth every 6 hours as needed for anxiety disorder for 14 days, manifested by restlessness, then re assess on 11/20/23. During a review of Resident 42's Medication Administration Record (MAR) for November 2023, the MAR indicated the Ativan order was renewed on 11/6/23 and Resident 42 received Ativan once on 11/7/23 and once on 11/8/23. 555199 Page 10 of 14 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

F 0758 During multiple observations on the following dates and times, the following were observed on Resident 42: Level of Harm - Minimal harm or potential for actual harm - 11/7/23 at 11:05 a.m., Resident 42 was sleeping. - 11/8/23 at 9:50 a.m., Resident 42 was sleeping. Residents Affected - Some - 11/8/23 at 10:26 a.m., Certified Nursing Assistant 5 (CNA 5) stated Resident 42 refused to get up because the resident felt dizzy. - 11/8/23 at 1:24 p.m., Resident 42 was sleeping. - 11/8/23 02:33 p.m., Resident 42 was sleeping. - 11/8/23 04:01 p.m., Resident 42 was sleeping. During an interview on 11/9/23 at 2:24 p.m., Licensed Vocational Nurse 3 (LVN 3) stated Resident 42 had periods of restlessness when the resident would attempt to remove her incontinent pad because she was wet. LVN 3 stated Resident 42 had periods of restlessness when she wanted to get up because she was wet, or she wanted to get up to the bathroom. LVN 3 stated she would give the Ativan to Resident 42 to ensure Resident 42's safety because she might attempt to get out of bed by herself. During an interview on 11/9/23 at 2:14 p.m., RN 1 stated Resident 42 had complained of dizziness which could be caused by low blood pressure, a lack of sleep, or it could be a side effect of Ativan. During a review of the facility's undated Policy and Procedure (P&P) titled Psychotropic and Psychotherapeutic Drugs, the P&P indicated when a decision is reached and made by the interdisciplinary team and the physician that the resident needs the psychotherapeutic drug, a written physician's order that specifies the duration of the use of the medication and the circumstances under which medication is to be used (health record must contain a diagnosis and the specific behavior manifestations for which the medication is being used) shall be obtained. 555199 Page 11 of 14 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

F 0838 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies. Based on interview and record review the facility failed to conduct and document one of one facility-wide assessment of staffing resources, necessary to care for the residents. This deficient practice had the potential to not meet the staffing needs of the facility. Findings: During a concurrent review of the facility's document titled Facility Assessment dated 10/26/23 and interview with the facility's Administrator (ADM) on 11/9/23 at 9:20 a.m., the facility assessment did not indicate that the staffing resources was completed. The ADM stated the facility assessment on staffing resources was not completed. The ADM stated the facility assessment needed to be complete to be able to ensure the resources necessary to provide the care and services for the residents residing at the facility. During a review of the facility's document titled Facility Assessment dated 10/26/2023, indicated the facility will identify the type of staff members or other health care professionals, and health care professionals that are needed to provide support and care for the residents. 555199 Page 12 of 14 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

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 ensure 18 of 21 resident bedrooms met the minimum requirement measurement of 80 square feet (sq. ft.) per resident in multi-bed occupancy resident bedrooms. Rooms 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 14, 15, 17, 18, 19, 20, and 22 measured less than 80 sq. ft. per resident in multi-bed occupancy bedrooms as indicated in the facility's Client Accommodation Analysis (square footage measurement of the residents' rooms), signed and dated by the administrator (ADM) on 11/9/23. This deficient practice had the potential to result in inadequate space needed to provide nursing care to the residents. Findings: During a review of the facility's Client Accommodation Analysis form, dated 11/9/23, the form indicated the following rooms did not meet the minimum 80 square feet per resident in multiple resident bedrooms: Room No. No. of Beds Room Square Footage # 1 4 301.11 sq ft # 2, 3, 5, 7, 10, 22 2 154.0 sq ft # 4 2 156.75 sq ft # 6 4 299.98 sq ft # 8,11, 12, 14, 17 2 155.87 sq ft # 18, 19, 20 2 155.87 sq ft #15 4 312.62 sq ft During an observation and concurrent interview with the ADM on 11/9/23 at 1:12 p.m., the ADM verified that the measurements of the 18 rooms on the accommodation analysis form did not meet the minimum 80 square feet per resident in multiple resident bedrooms. The ADM stated the facility would apply for room waivers for these rooms which are in accordance with the special needs of the residents, and that they will not adversely affect residents' health and safety. During a review of the facility's Room Waiver Request Letter (RWRL) and concurrent interview with the ADM on 11/9/23 at 1:30 p.m., the facility's RWRL dated 11/9/23, indicated there were 18 bedrooms that measured less than 80 sq. ft. per resident in multi-bed occupancy. During an observation of the 18 resident bedrooms for which a waiver was requested (Rooms 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 14, 15, 17, 18, 19, 20, and 22) on 11/9/23 at 1:33 p.m., there were spaces available sufficient for the residents' and staff's use and movement. There was no adverse effect as to the adequacy of the spaces for nursing care, comfort, and privacy to the residents. There were 555199 Page 13 of 14 555199 11/09/2023 Coast Care Convalescent Center 14518 E. Los Angeles St. Baldwin Park, CA 91706

F 0912 no residents that expressed any concerns about the room sizes. Level of Harm - Potential for minimal harm Residents Affected - Some 555199 Page 14 of 14