Health inspection·June 23, 2025

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to revise fall interventions to prevent repeated falls for one of four residents (Resident 1). Resident 1 was at risk for fall. As a result, Resident 1 suffered an unwitnessed fall on 6/07/2025 and was transferred to a general acute care hospital (GACH - a health facility having professional responsibility and an organized medical staff that provides 24-hour inpatient care) for further evaluation and care. The deficient practice also had the potential for Resident 1 to sustain serious injury and death. Findings: During a record review, the admission Record indicated Resident 1 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including unspecified dementia (a condition in which a person loses the ability to think, remember, learn, make decisions, and solve problems), displaced fracture of the neck of the femur (thigh bone), lack of coordination, and difficulty walking. During a record review, Resident 1's Care Plan (CP- a guideline for nurses to help them create and achieve a solid plan of action in the treatment of a patient)) on decline functional mobility and difficulty walking was created on 11/14/2024. The CP had a revision date of 6/06/2025. There CP goals and interventions did not reflect Resident 1 fell again on 6/07/2025. During a record review, Resident 1's Fall Risk Assessment (evaluates a person's likelihood of falling and identifies factors that increase their risks) dated 2/12/2025 indicated, Resident 1's fall risk score was three (a score of 10 or above represents high risk for falls). During a record review, Resident1's CP on actual fall incident initiated on 2/12/2025 and revised on 6/08/2025, indicated Resident 1 had a fall on 6/07/2025. The CP goal indicated Resident 1 will not sustain any injury from actual fall for a month. The CP interventions included to attend to Resident 1's needs immediately, to remind the resident to use the call light (a communication device that allows patients to request assistance from nurses or other healthcare staff), call light within reach, instruct Resident 1 to get up slowly and sit at the edge of the bed then stand up, and all items necessary that Resident 1 needed must be reachable. The CP goals and interventions did not reflect that Resident 1 fell again on 6/07/2025. During a record review, Resident 1's CP on non-compliant with safety initiated on 2/18/2025. The CP goal indicated Resident 1 will have no further fall or injury from fall daily in the next 90 days. The CP did not reflect revised goals and interventions in how the facility would prevent repeated (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: 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 06/23/2025 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)