Health inspection·August 12, 2025

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a resident's call light (an alerting device for nurses or other nursing personnel to assist a patient when in need) was within easy reach for one of three (3) sampled residents, (Resident 2). This deficient practice had the potential to cause delay or not able to provide care and services for Resident 2's requests and needs to maintain Resident 2's safety and highest wellbeing.During a review of Resident 2's admission Record indicated Resident 2 was admitted to the facility on [DATE], and readmitted on [DATE], with diagnoses that included but not limit to type II diabetes mellitus (a chronic condition that happens when you have persistently high blood sugar levels. Insulin resistance is the main cause, and it has resulted in a condition where the kidneys are damaged and can't function properly), rheumatoid arthritis (a chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles), and spinal stenosis lumbar region without neurogenic claudication [refers to the narrowing of the spinal canal in the lower back, which compresses the spinal nerves but does not cause the characteristic symptom of neurogenic claudication (pain and cramping in the legs with walking or standing, relieved by bending forward.) Instead, patients may experience other symptoms like back pain, leg pain, or numbness and tingling in the legs]. During a review of Resident 2's Minimum Data Set (MDS- a mandated resident assessment tool), dated 6/13/2025, indicated Resident 2 had moderate impairment for cognitive skills (the function of the brain uses to think, pay attention, process information, and remember things), she can make her own daily decision. Resident 2 was able to follow commands. Resident 2 needs 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) to complete the activity for oral hygiene, toileting hygiene, personal hygiene, shower/bathe self, upper and lower body dressing, change of position, and transfer. During a concurrent observation and interview in Resident 2's room on 8/12/2025 at 10:19 AM with Resident 2, observed Resident 2's call device was tied to her right-side rail and the call device was hanging below her bed frame. During an interview with Resident 2, Resident 2 stated she did not know where her call device was, she would rather stay in bed instead of trying to reach out for her call device, Resident 2 stated she was afraid of fall. During a concurrent observation in Resident 2's room and interview on 8/12/2025 at 10:25 AM with CNA 1, CNA 1 stated Resident 2's call device was supposed to be within Resident 2 reach near her hands area, so the resident can receive the care and services she needs timely and to ensure her safety. During an interview on 8/12/2025 at 10:50 AM with Registered Nurse Supervisor (RNS), RNS stated the call light was supposed to be placed within Resident 2's reach for easy access so that residents can get their services in a timely manner and for safety monitoring. During an interview on 8/12/2025 at 10:55 AM with Director of Nurses (DON), DON stated the call light was supposed to be placed within Resident 2's reach for easy access, and the call light is to ensure timely responses to the Residents Affected - Few Page 1 of 2 555338 555338 08/12/2025 Brighton Care Center 1836 N. Fair Oaks Ave Pasadena, CA 91103

F 0558 Level of Harm - Minimal harm or potential for actual harm resident's requests, needs, and for safety monitoring.During a review of the facility's Policy and Procedure titled, Answering the Call Light, revised September 2022, indicated, the purpose of this procedure is to ensure timely responses to the resident's requests and needs. Ensure that the call light is accessible to the resident when in bed, from the toilet, from the shower or bathing facility and from the floor. Residents Affected - Few 555338 Page 2 of 2