Health inspection·July 11, 2024

F 0806 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to complete the food preference assessment within 48 hours as per facility policy and protocol for four of five sampled residents (Resident 1,2,3 and 4). This deficient practice had the potential to result in decreased meal intake which can then lead to weight loss. Findings: 1. A review of Resident 1 ' s admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses that included Charcot ' s joint (a destructive joint disorder initiated by trauma), left ankle and foot (progressive musculoskeletal condition that affects the joints) and diabetes mellitus (elevated blood sugar). A review of Resident 1's Minimum Data Set (MDS- a standardized assessment and screening tool) dated 5/6/2024, indicated that Resident 1 has intact cognition (mental process of thinking and understanding). A review of Resident 1 Food Preference Interview indicated that the interview was conducted on 7/11/2024. 2. A review of Resident 2 ' s admission Record indicated Resident 2 was admitted to the facility on [DATE] with diagnoses that included cerebral infarction (disrupted blood flow to the brain) and right hemiplegia (loss of muscle function on one side of the body). A review of Resident 2 ' s MDS dated [DATE], indicated Resident 2 has mild cognitive impairment. A review of Resident 2 ' s Food Preference Interview indicated that the interview was conducted on 7/11/2024. 3. A review of Resident 3 ' s admission Record indicated Resident 3 was admitted to the facility on [DATE] with diagnoses that included displaced intertrochanteric fracture of the left femur (a break in the left thigh bone) and depression (a constant feeling of sadness). A review of Resident 3's MDS dated [DATE], indicated the resident has intact cognition. A review of Resident 3 ' s Food Preference Interview indicated that the interview was conducted on (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: 555716 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 555716 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Park View Nursing and Subacute 6740 Wilbur Ave Opco, LLC Reseda, CA 91335 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)