Garden Park Care Center: Restraint Used Without Orders - CA
The April 28 inspection, triggered by a complaint, found that the facility had applied or allowed restraints on Resident 2 with no physician's order, no signed informed consent, no care plan, and no monitoring of the resident's hands or wrists while the mittens were on. The resident had been readmitted to Garden Park, transferred to an acute care hospital on April 15, and returned the same day.
What inspectors found when they started asking questions was a staff whose accounts didn't line up.
LVN 1, who had been assigned to Resident 2 during the evening shift on April 13 and had administered medications to him at 9 p.m., told inspectors by phone on April 23 that the resident had arrived at the facility already wearing the bilateral hand mittens. Asked whether there was a signed informed consent for the mittens, LVN 1 said, "Not that I'm aware of." Asked whether she had assessed the resident's hands and wrists while he was wearing them, she said no.
LVN 4, who had been assigned to Resident 2 on the morning shifts of April 14 and 15, told inspectors on the morning of April 28 that the resident had also come back to the facility with the mittens. She said she recognized them as a restraint, understood there were no orders for restraints, and said she had instructed a nursing aide to remove them.
The nursing aide said no such instruction was given.
CNA 1 told inspectors he had not been asked to remove any mittens from the resident's hands. He said the last time he saw the mittens, they were sitting inside the resident's closet. Last week, he said.
The director of nursing told inspectors she had no idea whether Resident 2 had been admitted with mittens. "Absolutely not," she said. "We don't do mittens." She went on to describe exactly what should have happened if a resident arrived wearing soft mitten restraints: physician's orders, consent, assessments, removal every two hours to check circulation, a care plan. None of it existed in the record.
Soft mitten restraints limit a person's ability to use their hands. For residents who are elderly, medically fragile, or cognitively impaired, that restriction can affect circulation, skin integrity, and the ability to call for help or reposition themselves. Restraints applied without orders or monitoring remove those safeguards entirely.
Inspectors reviewed the medication administration records, shift assignments, and medical records and found no documentation of any kind addressing the use of the restraints. No order. No consent. No assessment. No care plan entry. The record showed LVN 1 had been at the resident's bedside administering medications the night of April 13. The mittens, by her account, were already on his hands. There is nothing in the record to show anyone flagged it.
The administrator and director of nursing both acknowledged the findings at 3:30 in the afternoon on April 28.
What the inspection could not establish was how long Resident 2 had spent with restraints on his hands and no one checking whether the blood was still moving through them. The mittens, by the time inspectors got there, were in a closet.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Garden Park Care Center from 2026-04-28 including all violations, facility responses, and corrective action plans.
Download the official CMS inspection PDF from Medicare.gov
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: September 19, 2026 · Our methodology
GARDEN PARK CARE CENTER in GARDEN GROVE, CA was cited for violations during a health inspection on April 28, 2026.
The resident had been readmitted to Garden Park, transferred to an acute care hospital on April 15, and returned the same day.
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.