Health inspection·July 15, 2025

F 0641 Ensure each resident receives an accurate assessment. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure one out of three sampled residents (Resident 1) had an accurate resident assessment (the process of systematically evaluating a resident's needs, strengths, and preferences to promote quality of life) on the Minimum Data Set ([MDS]- resident assessment tool) assessment for wandering (a resident tendency to move about aimlessly repeatedly). This deficient practice of not accurately documenting on the MDS of Resident 1 wandering behavior placed the residents at risk of not receiving accurate treatment Findings: During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted to the facility on [DATE] and was readmitted on [DATE]. Resident 1 diagnoses Alzheimer's Disease (a disease characterized by a progressive decline in mental abilities), anxiety (a vague, uneasy feeling of discomfort or dread), and dementia (a progressive state of decline in mental abilities). During a review of Resident 1's History and Physical (H&P), dated 7/28/2024, the H&P indicated Resident 1 did not have the capacity to understand and make decisions. During a review of Resident 1's MDS, dated [DATE], had indicated Resident 1's cognition (ability to learn, reason, remember, understand, and make decisions) was severely impaired. The MDS indicated Resident 1 exhibited behavioral symptoms such as hitting, screaming, and rummaging. The MDS indicated Resident 1 required partial/moderate assistance (helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort ) from staff for personal hygiene and dressing. During a record review of Resident 1's progress notes, dated 1/31/2025 and 4/9/2025, the progress note indicated Resident 1's risk factor was wandering behavior. During a record review of Resident 1's progress notes, dated 3/24/2025, indicated Resident 1 was monitored for taking other resident belongings while propelling herself throughout the facility. During a record review of Resident 1's care plan titled, Resident has a behavior of entering other resident's room, dated 3/25/2025, the interventions monitor resident's whereabouts and direct her into her room when observed entering other resident's room. During a record review of Resident 1's MDS, dated [DATE], the MDS indicated Resident 1 did not exhibit wandering behavior. During an interview on 7/15/2025 at 2:07 p.m. with Certified Nursing Assistant (CNA) 1, the CNA stated Resident 1 did wandered and tried to go into other Residents' rooms. CNA 1 stated Resident 1 attempted to go into other Residents' rooms daily and needed to be redirected. During a concurrent interview and record review on 7/15/2025 at 2:41 p.m. with MDS Coordinator Nurse, Resident 1's MDS, dated [DATE], indicated Resident 1 did not exhibit wandering behavior. A review of facility's policy and procedure (P&P) titled, Resident Assessment Instrument, dated 10/2023, indicated each discipline assigned to complete the designated section of the MDS assessment is responsible for the accuracy of the information. The MDS Coordinator Nurse stated the MDS should reflect the condition of the resident so the staff can manage the condition of the resident. During a concurrent interview and record review on 7/15/2025 at 3:00 p.m. with Director of Nursing (DON), Resident 1's MDS, dated [DATE], indicated Resident 1 did not exhibit wandering behavior. The DON Residents Affected - Few Page 1 of 2 555306 555306 07/15/2025 Kei-Ai South Bay Healthcare Center 15115 S Vermont Ave Gardena, CA 90247

F 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few stated the MDS was not accurate, and Resident 1 did exhibit wandering behavior. The DON stated MDS should coincide with the behavior of the residents. During a concurrent interview and record review on 7/15/2025 at 4:05 p.m. with Social Service Assistant (SSA) 1, Resident 1's MDS, dated [DATE], indicated Resident 1 did not exhibit wandering behavior. SSA 1 stated the MDS was presented that she was not a wanderer, and the nursing staff is presenting that Resident 1 was a wanderer. SSA 1 stated it was important to accurately document the MDS to provide accurate care for Resident 1. During a review of facility's policy and procedure (P&P) titled, Resident Assessment Instrument, dated 10/2023, the P&P indicated each discipline assigned to complete the designated section of the MDS assessment is responsible for the accuracy of the information. 555306 Page 2 of 2