Health inspection·May 9, 2025

F 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. 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 the provision of medically-related social services to meet one of five sampled residents (Resident 4) needs by failing to follow up the status of Resident 4's missing rollator walker (a mobility aid designed for residents who need support while walking) and ensure timely replacement of Resident 4's missing rollator walker. On 10/26/2024, Resident 4 was discharged from the facility without providing Resident 4's rollator walker. Residents Affected - Few This deficient practice placed Resident 4 at risk for health and safety impacts such as impairing Resident 4's ability to walk safely leading to fall and injury, reduced mobility (movement), and loss of independence which can lead to decreased self-esteem (confidence in one's own abilities or worth) and a sense of helplessness. Findings: During a review of Resident 4's admission Record, the admission Record indicated the facility admitted the resident on 3/27/2024 with diagnoses that included systemic lupus erythematosus (a chronic autoimmune disease in which the body's immune system mistakenly attacks its own healthy tissues and organs), cerebral infarction (refers to brain damage caused by a lack of blood flow [ischemia] to a part of the brain) and difficulty in walking. During a review of Resident 4's Minimum Data Set (MDS- a resident assessment tool) dated 10/18/2024, the MDS indicated Resident 4 had intact cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and senses). The MDS indicated Resident 4 required supervision with oral hygiene and partial or moderate assistance from staff with toileting hygiene, shower or bathing and lower body dressing. During a review of Resident 4's Inventory List dated 10/26/2024, the Inventory List indicated Resident 4 had a walker; however, the section indicating that the item (rollator walker) was received in satisfactory condition upon discharge was left blank. Upon further review of the Inventory List, there were no signatures from either the facility representative or Resident 4 (or Resident 4's Responsible Party [RP]) to confirm the return of the walker. During a concurrent interview and record review on 5/9/2025 at 2:25 p.m., with Social Services Assistant 1 (SSA 1), Resident 4's Inventory List dated 10/26/2024 was reviewed. SSA 1 stated there was no documented evidence found indicating Resident 4's walker was provided to Resident 4 upon Resident 4's discharge on [DATE]. SSA 1 stated that on 10/26/2024, Resident 4 was discharged without her (Resident 4's) walker. SSA 1 stated she (SSA 1) should have followed up with Resident 4 in obtaining her (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: 555574 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 555574 B. Wing A. Building (X3) DATE SURVEY COMPLETED 05/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Stoney Point Healthcare Center 21820 Craggy View St. Chatsworth, CA 91311 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)