Health inspection·May 30, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to report a fall accident that happened on 5/15/2025 accordance of facility ' s policy for one (1) of 2 (two) sampled residents (Resident 1). This failure not only resulted in a delay of an onsite inspection by the California Department of Public Health (CDPH) to investigate incident of fall, but also lead to delay of prevent further falls to ensure safety of Resident 1 and other residents in the facility. Findings: During a review of Resident 1's admission Record indicated Resident 1 was initially admitted to the facility on [DATE], and readmitted to the facility on [DATE], with diagnoses that included but not limit to fracture of nasal bones subsequent encounter for fracture with routine healing (the patient is receiving aftercare and follow-up visits for the injury after initial active treatment and the fracture is healing normally), history of falling, chronic obstructive pulmonary disease [(COPD), a progressive lung disease that makes it difficult to breathe] and type II diabetes (a chronic disease where the body either doesn't produce enough insulin or can't effectively use the insulin it produces, leading to high blood sugar levels). During a review of the Minimum Data Set, [(MDS)- (a resident assessment tool)] dated 5/15 /2025, indicated Resident 1 had moderate impairment (decisions poor, cues/supervision required) for cognitive skills (the mental processes that allow people to think, learn, and solve problems) for daily decision making. Resident 1 need partial or moderate assistant, (helper does less than half the effort) with the eating, oral hygiene, personal hygiene, toileting, upper and lower body dressing. Resident 1 needs supervision or touching assistance, (helper provides verbal cues and /or touching/steadying and/or contact guard assistance as resident completes activity) for shower/bathe self, change of position, and transfer. During an interview on 5/29/2025 at 11:25 AM with Resident 1 at Resident 1 ' s room, Resident 1 stated she was trying to grab her wheelchair, and she was going to go to the activity room, she then lost her balance and landed face down and Resident 1 ' s nose got injured. Resident 1 stated it was early morning, her nose got injured, she did not remember she was sent to the hospital for further care after her nose injury from her fall. During an telephone interview on 5/29/2025 at 3:29 PM with Licensed Vocational Nurse 1(LVN1), LVN1 stated Resident 1 had an accident of unwitnessed fall on 5/15/2025 near 5:00 AM. LVN 1 stated he was the nurse for Resident 1 for that shift, he called physician, notified her conservator and he had (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: 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 05/30/2025 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)