Health inspection·August 7, 2024

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 of three sampled residents (Resident 1) who was admitted in the facility with cellulitis (skin infection caused by bacteria) of the right and left lower limb (leg) received care and services to meet the resident ' s needs by failing to: Residents Affected - Few 1. Ensure Resident 1 received wound treatment as ordered by the physician. 2. Complete a weekly assessment of Resident 1 ' s wound. This deficient practice placed Resident 1 at risk for worsening, complications, and poor healing of the resident ' s skin condition. Findings: During a review of Resident 1 ' s admission Record, the admission Record indicated Resident 1 was admitted on [DATE], and re-admitted on [DATE] with diagnoses including infection of the skin and subcutaneous tissue ( bacterial, viral, or fungal – that enters any break in the skin and invade the subcutaneous tissue), lymphedema (swelling caused by a buildup of fluid in the body between the skin and muscle), and venous stasis dermatitis of both lower extremities (condition in which skin of the lower legs becomes swollen or inflamed). During a review of Resident 1 ' s Minimum Data Set ([MDS] a standardized assessment and care screening tool), dated 6/25/2024, the MDS indicated Resident 1had the ability of understand and be understood by others. The MDS indicated Resident 1 required partial/ moderate assistance with activities of daily living (ADLs) such as dressing, toilet use, personal hygiene, transfer (moving between surfaces to and from bed, chair, and wheelchair) and bed mobility (how resident moves from lying to turning side to side). During a review of Resident 1 ' s physician order dated 7/14/2024, the order indicated to cleanse Resident 1 ' s Left and Right lower extremity (legs) with Dakin ' s solution (a dilute sodium hypochlorite (NaClO) solution commonly known as bleach) x 7 days, apply Bactroban ointment (treatment of certain types of skin infections) to open areas and cover with kerlix every day shift for 7 days. During a review of Resident 1 ' s Progress Notes dated 7/16/2024 at 2:40 p.m., the Notes indicated, Resident 1 refused wound treatment and stated he did not have time as he was going out. The Progress Notes indicated the treatment would be endorsed to oncoming shift. There were no supporting documentation to indicated Resident 1 ' s wound treatments were completed on 7/16/2024 after returning to the facility. (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: 555340 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 555340 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/07/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marina Pointe Healthcare & Subacute 5240 Sepulveda Blvd Culver City, CA 90230 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)