Health inspection·September 25, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. Based on observation, interview, and record review, the facility failed to maintain residents' room temperature level between 71-81 degrees Fahrenheit (F- unit of measure for temperature), as required by the federal regulation for one of three sampled residents (Resident 3) and two of seven rooms (Room A and Room B). This deficient practice resulted in the Resident 3's increased level of discomfort and had the potential to negatively impact the residents' quality of life. Findings: During a review of Resident 3's admission Record, the document indicated the facility admitted the resident on 9/12/2024 with diagnoses that included left pelvic (the area of the body below the abdomen that is located between the hip bones) fracture (a partial or complete break in the bone), left hip fracture, heart failure (when the heart muscle does not pump blood as well as it should), and insomnia (difficulty falling or staying a sleep). During a review of Resident 3's History and Physical (H&P- a formal assessment by a healthcare provider that involves a resident interview, physical exam, and documentation of findings) dated 9/13/2024, the document indicated Resident's 3 baseline cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) indicated recognizes daily routine, people without prompts or repetition. During a concurrent observation and interview on 9/18/2024 at 10:45 a.m., with the Maintenance Supervisor (MS), observed residents' room temperatures for Room A and Room B. The MS used the facility's laser thermometer (an instrument for measuring and indicating temperature) to check room temperatures in the facility. During the observation, Room A was found to have a temperature of 65 degrees F and Room B had a temperature of 69.5 degrees F. The MS stated that resident rooms are required to be between 71 degrees F and 81 degrees F. The MS stated that he will need to adjust the thermostat to reach the required temperature. During a concurrent interview and observation on 9/18/2024 at 11:20 a.m., with Resident 3 in Room A, Resident 3 was observed to have a blanket covering her body from her chest to her feet. Resident stated that she had been admitted to the facility for one week. Resident 3 stated that during her stay at the facility, her room has been cold and that she is using an extra blanket to keep warm. During an interview on 9/25/2024 at 1:00 p.m., with the Administrator (ADM), the ADM stated that resident rooms are required to be between 71 degrees F and 81 degrees F. The ADM stated that an (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 4 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 09/25/2024 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)