Health inspection·August 27, 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, medical record review, and facility P&P review, the facility failed to develop a plan of care to reflect the individual care needs for two of three sampled residents (Residents 1 and 2). * The facility failed to develop a care plan to address Resident 1's wandering behavior by attempting to enter to other female rooms. * The facility failed to develop a care plan to address Resident 2's elopement risk. These failures posed the risk of the residents not receiving the appropriate treatment and services.Findings: Review of the facility's P&P titled Comprehensive Care Plans reviewed/revised 12/2022 showed it is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment. According to the Fundamentals of Nursing 10th edition, Communicating and Recording the Nursing Care Plan, a well written care plan is prepared by the nurse who best knows the patient and is recorded on the day the patient presents for treatment and care, according to facility policy, with modifications to the initial plan signed and dated. 1. Closed medical record review for Resident 1 was initiated on 8/26/25. Resident 1 was admitted to the facility on [DATE], and discharged on 8/24/25. Review of Resident 1's MDS assessment dated [DATE], showed the resident had severe cognitive impairment. Review of Resident 1's eINTERACT Change in Condition Evaluation - V 5.1 dated 8/13/25, showed the resident attempted to enter other female rooms. Further review of Resident 1's medical record failed to show documented evidence the care plan for the wandering behavior of attempting to enter to other female rooms was developed before the resident eloped on 8/17/25. On 8/27/25 at 1401 hours, an interview and concurrent closed medical record review for Resident 1 was conducted with RN 2. RN 2 verified Resident 1 had wandering behavior by attempting to enter to other female rooms on 8/13/25, and the care plan was not initiated until 8/17/25, when the resident eloped. RN 2 stated the licensed nurse should have started the care plan on 8/13/25. On 8/27/25 at 1632 hours, an interview and concurrent closed medical record review for Resident 1 was conducted with the DON. The DON acknowledged the above findings. The DON stated the licensed nurse should have initiated the care plan as soon as Resident 1's wandering behavior was observed. 2. Medical record review for Resident 2 was initiated on 8/26/25. Resident 2 was admitted to the facility on [DATE]. Review of Resident 2's Elopement Risk - V 3 assessment dated [DATE], showed the resident was at risk for elopement. Review of Resident 2's MDS assessment dated [DATE], showed the resident's cognition was moderately impaired. Further review of Resident 2's medical record failed to show documented evidence a care plan was developed to address the resident's elopement risk before 8/18/25. The care plan for Resident 2's elopement risk was created on 8/18/25. On 8/27/25 at 1340 hours, an interview and concurrent medical record review was conducted with RN 2. RN 2 verified Resident 2's Elopement Risk - V 3 assessment dated [DATE], showed the resident was at (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 3 Event ID: 555536 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 555536 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/27/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park Regency Care Center 1770 W. LA Habra Blvd. LA Habra, CA 90631 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)