Health inspection·October 23, 2024

F 0552 Ensure that residents are fully informed and understand their health status, care and treatments. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure a qualified facility approved interpreter was provided for one of three sampled residents (Resident 2 ). This failure resulted in Resident 2 being unable to communicate his needs with staff. Residents Affected - Few Findings: During a concurrent observation and interview on 10/22/24 at 11:55 am with Lead Registered Nurse (LRN) 1 on Unit 404, Resident 2 was speaking Spanish to staff. LRN 1, who is not spanish speaking, stated Resident 2 was Spanish speaking and needed an interpreter. LRN 1 stated she was unaware of who the approved interpreters were for the facility. LRN 1 further stated she used either another resident or non-facility approved interpreters to communicate with Resident 2. During an interview on 10/22/24 at 12:16 pm with Registered Nurse (RN) 2, RN 2 stated he called the on-call doctor on 10/18/24 to evaluate Resident 1 when the resident complained of scrotum pain. RN 2 stated Medical Doctor (MD) 1 used Licensed Vocational Nurse (LVN) 1 to translate for Resident 2 during the evaluation. RN 2 stated, after evaluating Resident 2, MD 1 reported that Resident 2 complained a male staff member inappropriately grabbed his scrotum causing him pain. RN 1 stated he did not know if LVN 1 was an approved interpreter for the facility. RN 2 confirmed there was no way to ensure LVN 1's translation was accurate. During an interview on 10/23/24 at 12:11 pm with Resident 2 and RN 3, RN 3 stated he became a facility approved Spanish interpreter after passing a proficiency test. RN 3 translated for Resident 2; Resident 2 stated he reported pain to his scrotum after a staff member assisted him with personal care. Resident 2 further stated police later interviewed him asking if the staff member inappropriately touched him or purposefully harmed him. Resident 2 stated he was confused why police were involved because he did not report a malicious act, just pain. Resident 2 further stated I feel like a bothersome to staff because I want to speak my native language of Spanish and they don't. During a concurrent interview and record review on 10/23/24 at 12:21 pm with Supervising Registered Nurse (SRN) 1, [facility's name] Bilingual Pay Log dated 10/23/24 was reviewed. The [facility's name] Bilingual Pay Log indicated, LVN 1 was not a facility approved interpreter. SRN 1 confirmed there was no Spanish speaking interpreter available to assist Resident 2 on 10/18/24. The [facility's name] Bilingual Pay Log indicated, there was no Spanish speaking interpreter available during evening shifts. SRN 1 stated she did not know what staff should do when a facility approved interpreter was not available. SRN 1 further stated there was no process in place to ensure facility approved interpreters were available each shift. During an interview on 10/23/24 at 1:46 pm with Social Worker (SW) 1, SW 1 stated, We are limited (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: 555731 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 555731 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/23/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Dept of State Hospitals - Metropolitan Snf 11401 South Bloomfield Avenue Norwalk, CA 90650 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)