Health inspection·August 24, 2023

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, medical record review, and facility P&P review, the facility failed to develop a care plan for one of two sampled residents (Resident 1) to address Resident 1's behavioral concerns with Resident 2. This failure posed the risk of not providing appropriate and consistent care to Resident 1. Findings: Review of the facility's P&P titled Care Plans, Comprehensive Person-Centered reviewed 3/2023 showed the facility will update the resident's care plan when there has been a significant change in the resident's condition. Medical record review for Resident 1 was initiated on 08/23/23. Resident 1 was admitted to the facility on [DATE],with a diagnosis of schizophrenia. Review of Resident 1's Progress Notes showed Resident 1 reported concerns of Resident 2's inappropriate social skills as follows: - The progress note dated 6/27/23, showed Resident 1 complained to the staff of Resident 2 touching him. Resident 1 stated he was uncomfortable. - The progress note dated 7/3/23, showed Resident 1 complained to staff of Resident 2 touching him again. The note further showed Resident 2 admitted to friendly touch on Resident 1's chest. - The progress note dated 7/13/23, showed Resident 1 complained to the staff of Resident 2 touching his hand and attempting to hug him. - The progress note dated 7/26/23, showed Resident 1 was observed by the staff yelling in the hallway. Resident 1 stated he was mad at Resident 2 for sticking her tongue out at him. The note further showed Resident 1 asked for a medication to help him relax. - The progress note dated 7/27/23, showed Resident 1 complained to the staff that Resident 2 touched his hand. Review of Resident 1's Care Plan showed a care plan dated 8/23/23, addressing Resident 1's concerns of unwanted touch from Resident 2. On 8/23/23 at 1450 hours, an interview and concurrent medical record review was conducted with MHS (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: 555388 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 555388 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Beach Creek Post-Acute 645 South Beach Blvd. Anaheim, CA 92804 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)