Health inspection·November 8, 2023

F 0656 Level of Harm - Potential for minimal harm Residents Affected - Some 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 and medical record review, the facility failed to develop the comprehensive person-centered care plan for one of four sampled residents (Resident 1). * Resident 1 consistently refused showers and hygiene care. The facility did not develop a care plan problem to address the refusal of care. This failure put Resident 1 at risk of not having their care needs met. Findings: Closed medical record review for Resident 1 was initiated on 11/7/23. Resident 1 was readmitted to the facility on [DATE], and transferred to the acute care hospital on [DATE]. Review of Resident 1 ' s Shower Day Skin inspection forms dated 10/6/23 and 10/28/23, showed Resident 1 refused to shower on her scheduled shower days. Review of Resident 1 ' s plan of care failed to show a care plan problem addressing Resident 1 ' s refusal to shower. On 11/7/23 at 1223 hours, an interview was conducted with LVN 1. LVN 1 was asked about care and services provided to Resident 1, specifically hygiene care. LVN 1 stated Resident 1 often refused treatments and showers. On 11/7/23 at 1243 hours, an interview was conducted with CNA 1. CNA 1 stated Resident 1 would often refuse hygiene and would not let the staff change the linens on the bed. On 11/7/23 at 1420 hours, a telephone interview was conducted with CNA 2. CNA 2 stated Resident 1 would usually refuse everything, including hygiene care. CNA 2 stated he informed the charge nurse of the resident ' s refusal. On 11/7/23 at 1426 hours, an interview and concurrent closed medical record review was conducted with RN 1. RN 1 was asked about the process regarding a resident refusing care and services, RN 1 stated part of the process included to update the plan of care. RN 1 stated any licensed nurses could update the plan of care. RN 1 was asked to review Resident 1 ' s closed medical record and show evidence a care plan problem was developed for Resident 1 ' s refusal of care, including showers. RN 1 stated there was no care plan problem to address the refusal of care. (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 4 Event ID: 555688 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 555688 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/08/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Anaheim Point 3415 W Ball Road 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)