Health inspection·March 11, 2025

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure a call light device (also known as a call bell or nurse call button, is a device typically found near a patient's bed or within reach. consists of a button that, when pressed, sends a signal to the nursing station or a centralized system, alerting healthcare providers that assistance is required in the room) was within reach for two of three sampled residents (Resident 2 and 3). Residents Affected - Few This failure had the potential to result in a delay in care and not receiving assistance timely. Findings: During a review of Resident 2 ' s admission Record, the admission Record indicated the facility admitted Resident 2 on 2/2/2017 with diagnoses that included unspecified (unconfirmed) Alzheimer ' s Disease (a disease characterized by a progressive decline in mental abilities), essential hypertension (HTN-high blood pressure) and cognitive communication deficit (difficulty communicating due to a disruption in cognitive processes like attention, memory, and reasoning, rather than a primary language or speech problem). During a review of Resident 2 ' s History and Physical (H&P - a medical examination that involves a doctor taking a patient's medical history, performing a physical exam, and documenting their findings), dated 4/15/2023, the H&P indicated Resident 2 did not have the capacity to understand and make decisions. During a review of Resident 2 ' s Minimum Data Set (MDS - a resident assessment tool), dated 12/1/2024, the MDS indicated Resident 2 ' s cognitive (mental action or process of acquiring knowledge and understanding) skills for daily decisions was severely impaired. The MDS indicated Resident 2 needed moderate assistance from staff for toileting, dressing and personal hygiene. During a review of Resident 2 ' s Care Plan about self-care deficit (when someone has trouble performing daily tasks related to health and well-being), created on 5/29/2018 and last revised on 3/10/2025, the Care Plan indicated an intervention that call light will be within reach and attend needs promptly. During a review of Resident 3 ' s admission Record, the admission Record indicated the facility admitted Resident 3 on 9/8/2021 with diagnoses that included chronic obstructive pulmonary disease (COPD-chronic lung disease causing difficulty in breathing), muscle weakness and Alzheimer ' s Disease. During a review of Resident 3 ' s H&P, dated 1/28/2025, the H&P indicated Resident 3 did not have (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: 555690 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 555690 B. Wing A. Building (X3) DATE SURVEY COMPLETED 03/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Alameda Care Center 925 W. Alameda Ave. Burbank, CA 91506 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)