F 0585
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Honor the resident's right to voice grievances without discrimination or reprisal and the facility must
establish a grievance policy and make prompt efforts to resolve grievances.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
interview and record review, the facility failed to ensure one of three sampled residents (Resident 1) was
informed in writing of the findings of the investigations and the corrective actions needed after grievances (a
formal, written or verbal expression of dissatisfaction regarding the quality of care, services, or treatment
from a provider or health plan) were received in accordance with facility's Policy and Procedures (P&P)
titled Filing Grievances/Complaints. This deficient practice violated Resident 1's right to be informed of the
outcome and actions required from the facility after a grievance was filed to address Resident 1's concerns
and had the potential for needs to be unresolved. Findings: During a review of Resident 1's admission
Record (AR), the AR indicated Resident 1 was initially admitted on [DATE] with diagnoses including
following (condition after a specific event or procedure) surgical amputation (surgical removal of the
portion), acute osteomyelitis (sudden inflammation of bone or bone marrow, usually due to infection) of
right ankle and foot, and diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control
and poor wound healing). A review of Resident 1's Minimum Data Set (MDS - a resident assessment tool)
dated 1/6/2026, the MDS indicated that Resident 1's had intact cognitive function (thought process or
decision consistent/reasonable). The MDS also indicated that Resident 1 did not exhibit any physical or
verbal behavioral symptoms directed toward others (e.g., threatening others, screaming at others, cursing
at others). During a review of the nine (9) Grievance/ Complaint/ Theft and Loss (GCT) Forms filed by
Resident 1, including stapled attachments dated from 8/25/2025 to 1/26/2026 each GCT form indicated
documentation of grievance, investigation including recommended corrective action, and resolutions of
grievance. The GCT form did not indicate the investigation findings, the date and documentation that
Resident 1 was informed of the investigation findings as well as corrective actions that would be taken. The
GCT form did not indicate a date when Resident 1 signed the form. During a concurrent interview and
record review on 2/10/2026 at 2:45 PM with Resident 1, Resident 1 stated that he signed the GCT forms
when social service director (SSD) 1 originally presented him with the forms. Resident 1 stated SSD no
longer worked in the facility and the forms were provided to Resident 1 to sign. Resident 1 stated he was
never informed of the investigation findings and actions taken. During a concurrent interview and record
review on 2/10/2026 at 3:50 PM with Director of Nursing, Resident 1's GCT Forms and Social Service
Progress Note (SSPN) were reviewed. DON stated there were no documented findings during the
investigation written in the GCT forms, SSPN, and Resident 1's medical record that indicated Resident 1
was informed of the findings, and what the corrective actions were based on the investigation. DON stated
SSD 1 should have dated the GCT form on the date the grievance was resolved and should have provided
a copy of the written summary of the investigation to Resident 1 and document the resolution on Resident
1's medical record. The DON stated Resident 1 signed the form when the grievance was filed by Resident
1,
(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:
555839
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
555839
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
02/10/2026
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Dreier's Nursing Care Center
1400 West Glenoaks Blvd
Glendale, CA 91201
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)
F 0585
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
FORM CMS-2567 (02/99)
Previous Versions Obsolete
however signed in the wrong place that indicated resolution, therefore no follow up actions were relayed to
Resident 1 regarding the filed grievance. During a review of the facility's Policy and procedure (P&P)
revised in 11/2010, the P&P indicated that upon receipt of a grievance and/or complaint, the identified
department will investigate the allegations and submit a written report of such findings to the Administrator
within five (5) working days of receiving the grievance and/or complaint. The P&P also indicated that the
resident or person filing the grievance and/or complaint on behalf of the resident, will be informed of the
findings of the investigation and the actions that will be taken to correct any identified problems. The
Administrator, or his or her designee, will make such reports orally within 7 (seven) working days of the
filing of the grievance or complaint with the facility. A written summary of the investigation will also be
provided to the resident, and a copy will be filed in the Social Service office.
Event ID:
Facility ID:
555839
If continuation sheet
Page 2 of 2