Health inspection·September 10, 2025

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure that Resident 1, a resident with dementia (loss of thinking, memory, and social abilities), was safely escorted to an outside appointment at GACH 1 for one of five sampled residents.This deficient practice resulted in the resident's safety being put at risk.During a review of Resident 1's admission Record (AR), the AR indicated the facility admitted Resident 1 to the facility on 8/18/2025 with diagnoses that included hypertension (a condition when the force of the blood against the artery walls is too high), epilepsy (cell activity in the brain is disturbed), and unspecified dementia (cognitive [ability to understand and process thoughts] decline). During a review of Resident 1's History & Physical Examination -V2 (H&P), dated 8/19/2025, the H&P indicated Resident 1 had the capacity to understand and make medical decisions. During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool), dated 8/25/2025, the MDS indicated Resident 1 was cognitively intact and required substantial/maximal assistance with walking 10 feet and was dependent for transfers. During a phone interview on 9/9/2025, at 10:40 a.m., with Family (FAM 1), FAM 1 stated Resident 1 had an appointment on 9/2/2025 at 12:30 p.m. at GACH 1. FAM 1 stated FAM 1 arrived at GACH 1 at 12:20 p.m. FAM 1 stated when FAM 1 arrived at GACH 1, Resident 1 was with provider and Resident 1's wheelchair was there, but no escort was there. FAM 1 stated Resident 1 had another appointment across the street at another office on the same day to have staples removed from Resident 1's head. FAM 1 stated FAM 1 did not see an escort. FAM 1 felt it was unsafe for Resident 1 to be left alone because Resident 1 has dementia. FAM 1 stated Resident 1 was left at the appointment site with Resident 1's medical documents. During an interview on 9/10/2025, at 3:26 p.m., with the Licensed Vocational Nurse (LVN 1), LVN 1 stated the facility will always send an escort, but they also ask the family if family will be available. LVN 1 stated, We don't send them without an escort. LVN 1 stated the only reason that residents will go without an escort is if the family meets them at the appointment or family will meet at the facility and then they go to an appointment. LVN 1 stated it is important to make sure the resident is safe, and that they come back, or there is not an incident of losing the resident and the resident arrives safely. LVN 1 stated LVN 1 is unsure if there is a written Policy stating that, but this is what LVN 1 hopes they're doing it and it's the protocol. During an interview on 9/10/2025, at 4:04 p.m., with the Social Services Director (SSD), the SSD stated staff escort the resident to the appointment and back, if needed. The SSD stated if the resident had a dementia diagnosis, the resident would need an escort. The SSD stated most of the residents in the facility go with an escort. The SSD stated the escort remains at the appointment and returns with the resident unless the family is going to meet them there and the family is okay with taking care of the resident. The SSD stated they must wait for the family before leaving and they can't just leave them there. The SSD stated it is important for safety. The SSD stated that when the Director of Staff Development (DSD) arranges for transportation and an escort, the DSD looks for if the resident needs physical help, a wheelchair, and if the resident is confused Residents Affected - Few (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 3 Event ID: 555729 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 555729 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arcadia Care Center 1601 S Baldwin Ave. Arcadia, CA 91007 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)