Health inspection·June 18, 2025

F 0557 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to treat one of four sampled residents (Resident 1) with respect and dignity by failing to ensure Resident 1 was assisted with getting dressed prior to him leaving for his appointment. This deficient practice resulted in Resident 1 to feel embarrassed because he had to wear a hospital gown (a loose-fitting garment, typically open in the back, that patients wear in medical facilities) to his appointment. This deficient practice had the potential for Resident 1 to be exposed causing unworthiness and psychosocial harm to Resident 1. Findings: During a review of Resident 1's admission Record (Face Sheet), the Face Sheet indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including acute kidney failure ([AKI] also called acute kidney injury - when the kidneys suddenly can't filter waste products from the blood), type 2 diabetes ([DM] a disorder characterized by difficulty in blood sugar control and poor wound healing), and colostomy (a surgical procedure that brings one end of the large intestine out through the abdominal wall to allow waste to leave the body). During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool), dated 5/30/2025, the MDS indicated Resident 1's cognition was intact. During a telephone interview on 6/17/2025 at 1:56 p.m., with Resident 1's Family Member (FM 1), FM 1 stated on 5/30/2025 at 7:30 a.m., she brought Resident 1 street clothes (ordinary clothes that people wear in public) to wear to his appointment. FM 1 stated when Resident 1 arrived at his appointment, he was still wearing a hospital gown and not the street clothes she brought for him to be changed into. FM 1 stated she was upset because Resident 1 expressed to her that he was embarrassed because he had to wear a hospital gown in public. During an interview on 6/18/2025 at 11:46 a.m., with the Case Manager (CM), the CM stated she received a phone call (after Resident 1's appointment on 5/30/2025) from Resident 1's FM 1 complaining that Resident 1 arrived at his appointment wearing a hospital gown. The CM stated CNA 1 reported to her that Resident 1 had refused to change into his clothes. During a concurrent interview and record review on 6/18/2025 at 3:26 p.m., with the Case Manager (CM), Resident 1's Clinical Records dated 5/2025 were reviewed. The Clinical Records indicated, there were no documentation indicating on 5/30/2025 that Resident 1 refused to change into his street (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: 555805 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 555805 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/18/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Bel Vista Healthcare Center 5001 East Anaheim Street Long Beach, CA 90804 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)