Health inspection·August 20, 2024

F 0558 Reasonably accommodate the needs and preferences of each resident. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that the call light (a device used by patients to call for assistance from hospital staff) was within reach (an arm's length) of one of three sampled residents (Resident 2). Residents Affected - Few This deficient practice had the potential to result in delayed provision of services, delay in care and not receiving assistance with activities of daily living (ADLS, activities related to personal care. They include bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating). Findings: During a review of the admission record indicated Resident 2 was initially admitted to the facility on [DATE] and re admitted on [DATE], with diagnoses that included but not limited to difficulty in walking, other lack of coordination, unspecified protein calorie malnutrition (a disorder caused by a lack of proper nutrition or an inability to absorb nutrients from food), unspecified dementia (a term used to describe a group of symptoms affecting memory, thinking and social abilities). During a review of Resident 2's History and Physical dated 1/21/2024 indicated Resident 2 does not have the capacity to understand and make decisions. During a review of the Minimum Data Set (MDS- a standardized assessment and care screening tool) dated 7/09/2024, indicated Resident 2 has impaired cognitive skills for daily decision making, and needed partial to moderate assistance (helper does less than half the effort) from the staff for the activities of daily living such as shower, and dressing, sit to stand, toilet transfers and chair to bed transfers. During a record review of Resident 2's care plan initiated on 7/06/2023 and revised on 8/24/2024 indicated Resident 2 was at risk for ADL self-care performance deficit related to unsteady gait, poor balance. The care plan interventions indicated to encourage the resident to use bell to call for assistance and to be sure the residents' call light is within reach and encourage the resident to use it for assistance as needed and the resident needs prompt response to all requests for assistance. During an observation in Resident 2's room and interview on 8/20/2024 at 8:08 am, Resident 2 was sitting up at the side of bed and call light was not placed within Resident 2's reach. Resident 2 stated she did not know where her call light was. Resident 2 stated, I do not know where my call light is, someone took it. I do not have one, but I have had one before, somebody just took it. If I have a fall, I do not know how I would call for help. (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: 555894 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 555894 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/20/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Foothill Heights Care Center 1515 North Fair Oaks Ave Pasadena, CA 91103 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)