Health inspection·January 10, 2024

F 0692 Provide enough food/fluids to maintain a resident's health. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide nutritional care and services to one of two sample residents (Resident 2) by failing to ensure implementation and modification of interventions consistent with Resident 2 ' s needs and goals per registered dietitian (RD) recommendations. Residents Affected - Few This deficient practice placed Resident 2 at risk for further weight loss. Findings: A review of Resident 2's admission Record indicated Resident 2 was admitted to the facility on [DATE], with diagnoses including left femur fracture (a break, crack or crush injury of the thigh bone), supraventricular tachycardia arrest (SVT-a condition when heart beats rapidly due to a problem with the heart ' s electrical impulse) and malnutrition (lack of sufficient nutrients in the body). A review of Resident 2's Minimum Data Set (MDS - a comprehensive standardized assessment and care-screening tool), dated 11/20/2023, indicated Resident 2 has moderately impaired cognition (mental action or process of acquiring knowledge and understanding) for daily decision-making and needing maximal assistance from staff for activities of daily living (ADLs-bed mobility, surface transfer, eating, walk in room, dressing, toileting, and personal hygiene). A review of Resident 2's nutritional care assessment completed by the RD, dated 12/18/2023, indicated Resident 2 had a potential for nutritional issues due to weight was less than ideal body weight. A review of facility ' s RD recommendations on 12/18/2023, RD recommendations indicated for Resident 2: 1. Add fortified (increasing the content of one or more micronutrients such as vitamins and minerals) to diet order (increase caloric concentration of food due to low body weight) 2. Ice cream (food preferences-lunch and dinner to increase calories) 3. Multivitamin with minerals supplement (variable by mouth intake) A review of Resident 2's order summary report, dated 11/17/2023, order summary report indicated a mechanical soft no added salt, finely chopped meat and vegetables texture with regular liquid consistency diet order for Resident 2. Order summary report indicated no other orders regarding RD recommendations. (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: 555849 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 555849 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/10/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Vista Del Sol Care Center 11620 West Washington Blvd Los Angeles, CA 90066 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)