Health inspection·November 6, 2024

F 0657 Level of Harm - Potential for minimal harm Residents Affected - Some Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and medical record review, the facility failed to ensure the comprehensive plan of care was revised to reflect the resident's current wound care treatment and interventions for each individual wound site as ordered for one of seven sampled residents (Resident 3). * Resident 3's care plan was not revised to address the wound site of left foot first metatarsal base and head arterial wounds. This failure posed the risk of not providing the resident with individualized and person-centered care. Findings: Medical record review for Resident 3 was initiated on 11/5/24. Resident 3 was admitted to the facility on [DATE], and readmitted on [DATE]. Review of Resident 3's physician's order dated 11/1/24, showed the following: - to provide wound care to sacrococcyx Sites #1 and #2 as follows: cleanse with NS, pat dry, apply Santyl (debridement agent) nickel thick layer and oil emulsion gauze, and cover with a dry clean dressing every day shift for 14 days and as needed for 14 days - to provide wound care to the right knee anterior skin tear as follows: cleanse with NS, pat dry, then apply Xeroform gauze (nonadherent dressing to maintain moist wound environment), and cover with a dry clean dressing every day shift for 14 days and as needed for 14 days. - to provide wound care to left inner/medial knee skin tear as follows: cleanse with NS, pat dry, then apply Xeroform gauze, and cover with a dry clean dressing every day shift for 14 days and as needed for 14 days. - to provide wound care to the left foot first metatarsal head and base arterial wound as follows: cleanse with NS, pat dry, then apply Santyl nickel thick layer, cover with moist gauze followed by a dry clean dressing every day shift for 14 days and as needed for 14 days. - to provide wound care to the left elbow skin tear as follows: cleanse with NS, pat dry, then apply Xeroform gauze and cover with a dry clean dressing Review of Resident 3's plan of care dated 11/1/24, showed wound management goals and interventions for the following wound sites: pressure injury to the sacrum coccyx Sites #1 and #2, right foot (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 5 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 11/06/2024 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)