Hawthorne Healthcare: Missing Care Plan for Schizophrenia - CA
The resident, identified in inspection records only as Resident 77, carried a complicated medical history. She had type 2 diabetes, a condition that makes blood sugar difficult to control and complicates wound healing. She had epilepsy. She had dementia severe enough that, according to a history and physical form dated February 26, 2026, she no longer had the capacity to understand or make decisions about her own care. A federally mandated assessment completed just days later, on March 4, confirmed her cognitive skills were severely impaired and that she depended on staff for basic daily activities.
She also had schizophrenia. And for that diagnosis, there was no care plan at all.
Care plans are the documents that tell staff what to do for a specific resident, day in and day out. They lay out what a person needs, what treatments they receive, and how staff should respond to the particular challenges a resident's conditions create. When inspectors reviewed Resident 77's care plan file on March 26, schizophrenia was not addressed anywhere in it.
The facility's own MDS coordinator, identified in the report as MDSN 2, confirmed this to inspectors during an interview that same morning. She said she did not see a schizophrenia care plan for Resident 77. She said psychiatric diagnoses were required to have care plans. And she said what the absence of one could mean for a resident like Resident 77: that the resident might not obtain the care and services she needed because of her diagnosis.
That acknowledgment came from inside the building, not from a federal investigator pressing a point. The person whose job includes overseeing these assessments said plainly that the care plan should have existed and did not.
For a resident who cannot speak for herself, who cannot track her own symptoms, who cannot tell a nurse that something is wrong or remind an aide what she needs, the care plan is a substitute for that voice. It is what remains when a person's own ability to advocate for herself is gone. Resident 77's dementia had taken that capacity entirely, according to her own medical records. What was left was supposed to be documentation. A plan. Staff who knew what to do.
The facility's own written policy on care planning, dated May 2025, describes the obligation in direct terms: a comprehensive, person-centered care plan must be developed for each resident, covering medical, nursing, mental, and psychosocial needs identified in the assessment. Schizophrenia is a mental health diagnosis. It was identified in Resident 77's records. The policy said a plan was required. No plan existed.
Inspectors classified the violation as causing minimal harm or potential for actual harm, affecting few residents. The finding did not rise to the level of immediate jeopardy, the most serious federal designation. But the classification describes the level of documented harm at the time of inspection, not what a resident without a psychiatric care plan might experience on an ordinary Tuesday when a new aide comes on shift and has no written guidance about what her diagnosis requires.
Hawthorne Healthcare & Wellness Centre sits on South Grevillea Avenue in Hawthorne, a city in Los Angeles County. The inspection was completed March 27, 2026.
Resident 77, severely cognitively impaired, dependent on staff for everything, unable to make decisions about her own care, had been living in that building without anyone having written down what her schizophrenia required of the people responsible for her.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Hawthorne Healthcare & Wellness Centre, Lp from 2026-03-27 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 18, 2026 · Our methodology
HAWTHORNE HEALTHCARE & WELLNESS CENTRE, LP in HAWTHORNE, CA was cited for violations during a health inspection on March 27, 2026.
The resident, identified in inspection records only as Resident 77, carried a complicated medical history.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.