Other·August 24, 2018

F000 INITIAL COMMENTS

F000 PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE The following reflects the findings of The Department of Public Health during the investigation of a Complaint. Complaint Number: CA00584830 Representing the Department of Public Health: Surveyor ID: 38550 RN, HFEN The inspection was limited to the specific Complaint investigated and does not represent a full inspection of the facility. One deficiency was issued for Complaint Number: CA00584830

F584 SS=E Safe/Clean/Comfortable/Homelike Environment F584 CFR(s): 483.10(i)(1)-(7) §483.10(i) Safe Environment. The resident has a right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely. The facility must provide§483.10(i)(1) A safe, clean, comfortable, and homelike environment, allowing the resident to use his or her personal belongings to the extent possible. (i) This includes ensuring that the resident can receive care and services safely and that the physical layout of the facility maximizes resident independence and does not pose a safety risk. (ii) The facility shall exercise reasonable care for the protection of the resident's property from loss or theft. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE 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. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 9WNH11 Facility ID: CA940000101 If continuation sheet 1 of 8 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555010 (X3) DATE SURVEY COMPLETED 07/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LONG BEACH POST ACUTE 1201 Walnut Ave Long Beach, CA 90813 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE §483.10(i)(2) Housekeeping and maintenance services necessary to maintain a sanitary, orderly, and comfortable interior; §483.10(i)(3) Clean bed and bath linens that are in good condition; §483.10(i)(4) Private closet space in each resident room, as specified in §483.90 (e)(2) (iv); §483.10(i)(5) Adequate and comfortable lighting levels in all areas; §483.10(i)(6) Comfortable and safe temperature levels. Facilities initially certified after October 1, 1990 must maintain a temperature range of 71 to 81°F; and §483.10(i)(7) For the maintenance of comfortable sound levels. This REQUIREMENT is not met as evidenced by: Based on observation, interview and record review, the facility failed to maintain comfortable and safe temperature levels between 71-81 degrees Fahrenheit (F), inside the residents' rooms, hallway, dining room and the rehabilitation room. The rehabilitation room, dining room and nine (Rooms 117, 118, 120, 125, 127, 129, 131, 133, and 137) of 28 resident rooms were above 81.0 degrees F. This deficient practice of improperly maintaining room temperatures put the residents in the affected rooms at risk for dehydration (excessive loss of body water) and/or heat stroke (a severe heat illness with a body temperature due to heat exposure). FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 9WNH11 Facility ID: CA940000101 If continuation sheet 2 of 8 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555010 (X3) DATE SURVEY COMPLETED 07/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LONG BEACH POST ACUTE 1201 Walnut Ave Long Beach, CA 90813 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE Findings: On July 14, 2018, at 9:55 a.m., during a tour of the facility, a large rotating fan was observed in the dining room with 20 residents present. One resident was observed seated in a wheelchair, fanning herself with a hat. On July 24, 2018, at 10 a.m., during an interview, Certified Nursing Assistant 1 (CNA 1) stated the area and rooms near Nurse's Station Two were hot. CNA 1 stated if the residents complained of being hot, they were placed in the dining room because the area had a large fan and was cooler than the resident's rooms. On July 24, 2018, at 10:10 a.m., during an interview, Resident 1 stated she was sweating because it had been really hot in the facility. Resident 1 stated she had been hot for the past two weeks, after she was moved from a cooler room in Station One, to her current room in Station Two. Resident 1 stated she notified the facility's staff of the heat but she was not offered or provided with a fan. Resident 1 stated she drank more ice water to help to cool her down, but had to walk to get the ice water from the nurse's station herself. At 10:21 a.m., on July 24, 2018, at 10:21 a.m., during an interview, the Maintenance Worker (MW) stated the facility's air conditioning (AC) units worked but do not blow as much air in Station Two. On July 24, 2018, at 10:30 a.m., during an interview, the Maintenance Supervisor (MS) stated the facility's temperatures were to be maintained between 71 degrees and 81 degrees F. The MS stated one of the facility's AC units (AC unit number five) had broken down on the previous day (July 23, 2018) at FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 9WNH11 Facility ID: CA940000101 If continuation sheet 3 of 8 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555010 (X3) DATE SURVEY COMPLETED 07/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LONG BEACH POST ACUTE 1201 Walnut Ave Long Beach, CA 90813 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE approximately 2 p.m. The MS stated technicians came and attempted to fix the unit but were unsuccessful. The MS stated if residents reported feeling hot, their room windows were opened or they were placed in the dining room. On July 24, 2018, at 10:45 a.m., during a concurrent observation and interview with the MS, the ambient temperatures were taken of residents' rooms, the hallway, kitchen and the rehabilitation room. The facility's temperature gun was used to check the temperatures, which revealed the following: A. The Rehabilitation Room temperature was 86.5 degrees F. One fan and three facility staff were observed in the room. B. Room 125's temperature was 84 degrees F. One resident was observed in the room and the window was closed. One small, black tabletop fan was observed on the bedside table. C. Room 127's temperature was 85.1 degrees F. Two residents were observed in the room and the room's window was open. No fans were observed in the room. D. Room 129's temperature was 84 degrees F. One resident was observed in the room and the room's window was open. No fans were observed in the room. E. Room 131's temperature was 84 degrees F. One resident was observed in the room and the room's window was open. No fans were observed in the room. F. The hallway near Nurse's Station Two temperature was 83.1 degrees F. G. The dining room's temperature was 81.6 FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 9WNH11 Facility ID: CA940000101 If continuation sheet 4 of 8 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555010 (X3) DATE SURVEY COMPLETED 07/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LONG BEACH POST ACUTE 1201 Walnut Ave Long Beach, CA 90813 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE degrees F. There were 20 residents in the room and one large fan was observed in the room. On July 24, 2018, at 10:55 a.m., during an interview, the AC Technician (AC TECH) stated it would take four to five hours for him to fix the broken compressor on AC unit number five. On July 24, 2018, at 10:58 a.m., during an interview, the Occupational Therapist (OT 1) stated it had been really hot in the rehab room. OT 1 stated he had to bring a fan from home to help in cooling the room. OT 1 stated prior to bringing in his personal fan, the rehabilitation room was too hot to have residents come in for therapy. On July 24, 2018, at 11:08 a.m., during an interview, LVN 1 stated it was very warm in the facility. LVN 1 stated if residents got too hot, it could cause them to become dehydrated. At 11:15 a.m., on July 24, 2018, during an interview in the presence of LVN 1, Resident 2 stated it had been hot at the facility for the last three days. Resident 2 stated he notified the staff of the elevated temperatures but nothing was done. Resident 2 denied being offered or provided with a fan. On July 24, 2018, at 11:20 a.m., during a concurrent observation and interview in the presence of LVN 1, Resident 3 stated he did not feel well because it was too hot in his room. A small, black fan was observed on Resident 3's bedside table. Resident 3 stated he could not sleep because it had been hot for the previous four to five days and the fan was not helping with the heat. Resident 3 stated it had been so hot the previous night that he went to the dining room approximately 2 a.m., to sit next to the fan and try to cool down. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 9WNH11 Facility ID: CA940000101 If continuation sheet 5 of 8 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555010 (X3) DATE SURVEY COMPLETED 07/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LONG BEACH POST ACUTE 1201 Walnut Ave Long Beach, CA 90813 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE On July 24, 2018, at 11:55 a.m., during a concurrent observation and interview, the Director of Nursing (DON) stated the facility placed the resident's in the dining room with the fan to help keep the resident cool. The DON stated cold water was provided to all residents in their rooms and in the dining room to help keep the residents hydrated. There were 27 residents observed in the dining room, none of the resident's had water and there was no water pitchers or containers located in the dining room. The DON stated the residents were currently being served coffee. On July 24, 2018, at 11:58 a.m., during an interview, the MS stated the facility only had one fan, which was being used in the dining room. On July 24, 2018, at 2:15 p.m., during an interview, the MS stated the facility had six AC units. The MS stated the AC units serving Station Two (AC units 4, 5 and 6) were older and further apart than the units serving Station One and the front of the facility. The MS stated AC unit five was the broken unit and served Rooms 125, 127, 129, 131, 133 and the rehabilitation room. The MS stated although AC units four (serving Rooms 117, 119, 121, 123, and the dining room) and six (serving Rooms 116, 118, 120, 135, 137, station 2 nursing station) were working, they were not strong enough to cool the rooms they served to keep the temperatures below 81 degrees F. The MS stated the hallways in Station Two were hot because there were not enough vents for the area to be cooled. At 2:20 p.m., on July 24, 2018, during a concurrent observation and interview with the MS, the ambient temperatures were taken of resident's rooms, the kitchen, hallway and FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 9WNH11 Facility ID: CA940000101 If continuation sheet 6 of 8 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555010 (X3) DATE SURVEY COMPLETED 07/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LONG BEACH POST ACUTE 1201 Walnut Ave Long Beach, CA 90813 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE rehabilitation room. The facility's temperature gun was used to check the temperatures, which revealed the following: A. The rehabilitation Room temperature was 88.7 degrees F. There were two fans in use, two residents and three facility staff observed in the room. B. Room 117's temperature was 81.8 degrees F. One resident was observed in the room and the window was closed. No fans were observed in the room. C. Room 118's temperature was 83.6 degrees F. One resident was observed in the room and the window was closed. No fans were observed in the room. D. Room 120's temperature was 82.7 degrees F. Two residents were observed in the room and the window was closed. No fans were observed in the room. E. Room 125's temperature was 85.6 degrees F. One resident was observed in the room and the room's window was closed. Two fans were observed in the room. F. Room 133's temperature was 84.9 degrees F. One resident was observed in the room and the room's window was closed. Two fans were observed in the room. G. The dining room's temperature was 84.7 degrees F. 15 residents were observed in the room. One large fan was observed in the room. H. The Hallway near Room 116 temperature was 84.5 degrees F. I. The Hallway near Room 119 temperature was 83.8 degrees F. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 9WNH11 Facility ID: CA940000101 If continuation sheet 7 of 8 PRINTED: 05/14/2026 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMB NO. 0938-0391 (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X1) MULTIPLE CONSTRUCTION A. BUILDING: ___________ B. WING: _______________ 555010 (X3) DATE SURVEY COMPLETED 07/27/2018 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE LONG BEACH POST ACUTE 1201 Walnut Ave Long Beach, CA 90813 (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (EACH DEFICIENCY MUST BE PRECEDED BY FULL REGULATORY OR LSC IDENTIFYING INFORMATION) ID PREFIX TAG PROVIDER'S PLAN OF CORRECTION (EACH CORRECTIVE ACTION SHOULD BE CROSS-REFERENCED TO THE APPROPRIATE DEFICIENCY) (X5) COMPLETE DATE A review of The Weather Channel's website found at www.weather.com indicated the temperature in the city the facility was located in was 83 degrees F at 2:53 p.m. on July 24, 2018. A review of the facility's policy and procedure titled, "Policy for Comfortable Environment," revised November 2017, indicated the facility staff would maintain temperatures at a comfortable level for residents. The policy indicated 70-75 degrees F was a comfortable level and the temperature could be adjusted to whatever the resident felt was a comfortable level. According to the policy, if a resident reported being too warm, they would be offered a fan. FORM CMS-2567(02-99) Previous Versions Obsolete Event ID: 9WNH11 Facility ID: CA940000101 If continuation sheet 8 of 8