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Inspection visit

Health inspection

IMPERIAL CARE CENTERCMS #5557071 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

This survey cited 1 deficiency. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

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. Based on interview and record review, the facility failed to follow its policies and procedures regarding individualized care planning by failing to develop and implement a comprehensive person-centered care plan (a plan of care that summarizes a resident's health conditions, specific care and services facility staff need to provide a resident to promote healing and prevent a worsening of a condition, and current treatments) addressing one of three sampled residents` (Resident 1) prednisone (a powerful steroid used to decrease swelling, inflammation, and allergies) use. This deficient practice increases the risks for Resident 1 to not understand the purpose of the medication's use, the possibility of treatment failure, and the lack of interventions for staff to monitor Resident 1 for any harmful adverse side effects related to taking the medication. FindingsDuring a review of Resident 1's admission Record, undated, the admission Record indicated the facility originally admitted Resident 1 on 2/26/2025, with diagnoses including muscle weakness (loss of strength), dysphagia (having difficulty swallowing), hypertensive heart disease with heart failure (a damaged heart due to long-term high blood pressure resulting in inefficient pumping), and chronic obstructive pulmonary disease (COPD- a chronic inflammatory lung disease that causes obstructed airflow, making it difficult to breath). During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool), dated 12/5/2025, the MDS indicated Resident 1's cognitive functioning (the ability to think, learn, remember, use judgment, and make decisions) was with moderate impairment. The MDS also indicated Resident 1 needed partial/moderate assistance (helper does less than half the effort) for toileting needs, showering or bathing, and assistance when applying footwear. During a review of Resident 1's Order Summary Report, the Order Summary Report indicated the following physician's order:- 2/12/2026 8:02 p.m., a telephone order for Prednisone (a powerful steroid used to decrease swelling, inflammation, and allergies) oral tablet 20 milligrams (mg-a unit of measurement), give one tablet by mouth one time a day for cough for five days. During an interview with Assistant Director of Nursing (ADON) on 2/6/2026 at 3:16 p.m., the ADON stated, The purpose of creating a care plan is to create goals for the resident (Resident 1) and address the needs. The ADON stated licensed staff did not develop a care plan for Resident 1`s prednisone use. The ADON stated staff should have created a care plan because there are side effects that could potentially be caused by the use of medications. The ADON stated care plan has goals and interventions such as monitoring of vital signs, any potential side effects, or to see if the resident was exhibiting any side effects. The ADON stated if the resident exhibits any side effects, staff are required to notify the doctor if the medication would need to be continued or discontinued. The ADON stated the failure here was not developing a care plan to address Resident 1`s Prednisone usage. During a review of the facility provided policy & procedure (P & P) titled Care Plans, Comprehensive Person-Centered with last revision date of 3/2022, the P & P indicated, A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs is (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: 555707 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 555707 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/09/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Imperial Care Center 11441 Ventura Blvd Studio City, CA 91604 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)
F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete developed and implemented for each resident. The policy also stated; 9. Care plan interventions are chosen only after data gathering, proper sequencing of events, careful consideration of the relationship between the resident's problem areas and their causes, and relevant clinical decision making. 10. When possible, interventions address the underlying source(s) of the problem area(s), not just symptoms or triggers. 11. Assessments of residents are ongoing, and care plans are revised as information about the residents and the resident's condition change.; Event ID: Facility ID: 555707 If continuation sheet Page 2 of 2

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Citations

1 citation recorded*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

  • 0656GeneralS&S Dpotential for harm

    F656 - Comprehensive Care Plans

    Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

FAQ · About this visit

Common questions about this visit

What happened during the February 9, 2026 survey of IMPERIAL CARE CENTER?

This was a inspection survey of IMPERIAL CARE CENTER on February 9, 2026. The surveyor cited 1 deficiency, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at IMPERIAL CARE CENTER on February 9, 2026?

Yes, 1 deficiency was cited, each with a CMS Scope and Severity grade. The first was: "Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be ..."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

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Next steps

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Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.