Health inspection·April 4, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a colostomy (a surgical procedure that brings one end of the large intestine out through the abdominal wall to allow waste to leave the body) care plan (a document that outlines the facility ' s plan to provide personalized care to a resident based on the resident ' s needs) per facility policy, for one of four sampled residents (Resident 2). These failures had the potential for Resident 2 to receive colostomy care that is not personalized to meet the specific needs identified above, which could result in decreased quality of care and quality of life. Findings: During a review of Resident 2 ' s admission Record, the admission Record indicated Resident 2 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses that included colostomy status, malignant neoplasm of colon and abscess (a collection of pus) of intestine. During a review of Resident 2 ' s discharge Minimum Data Set (MDS- a resident assessment tool), dated 3/17/2025, the MDS indicated Resident 2 has intact cognitive skills. The MDS indicated Resident 2 was partial moderate assistance for toileting hygiene, bathing, lower body dressing and setup or clean-up assistance (helper helps only prior to or following the activity completion) with eating, oral and personal hygiene. During a review of Resident 2 ' s Body/Skin Assessment, dated 3/26/2025, the Assessment indicated Resident 2 had a colostomy site on the abdomen. During a review of Resident 2 ' s Order Summary Report, dated 4/3/2025, the Order Summary Report indicated an order for colostomy placement on 3/17/2025. The Order Summary Report also indicated a treatment order to cleanse the colostomy site with normal saline (NS- a saltwater solution), pat dry and apply colostomy bag every dayshift, ordered on 3/26/2025. During a concurrent interview and record review on 4/3/2025 at 1:53PM with Treatment Nurse 1 (TN 1), Resident 2 ' s medical chart dated from 3/25/2025 to 4/3/2025 was reviewed. Resident 2 ' s chart did not indicate a care plan for Resident 2 ' s colostomy. TN 1 states there is no developed care plan to address Resident 2 ' s colostomy and there should have been. TN 1 stated there should be a care plan so that staff know what nursing interventions to provide including monitoring the stoma site for signs/symptoms of infection, the treatments to provide and the need to monitor any pain during treatment and the goals of care. TN 1 also stated a care plan was needed for staff to follow and know (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 6 Event ID: 555338 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 555338 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/04/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Brighton Care Center 1836 N. Fair Oaks Ave Pasadena, CA 91103 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)