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