Parkview Healthcare Center

F-F911.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 35 of 35 055671

F-F912.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 34 of 35 055671 Department of Health & Human Services Printed: 08/27/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 055671 B. Wing 05/01/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805

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)

F 0912 Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. Level of Harm - Potential for minimal harm 49324

Residents Affected - Some Based on observation and interview, the facility failed to ensure Room A measured at least 80 square feet per resident. Room A was a five-bed room, which measured 78.4 feet per resident if all the beds were filled. At the time of the survey, the room was occupied by five residents. This failure had the potential to negatively impact the residents' quality of life.

Findings:

On 4/28/25 at 0932 hours, an initial tour of the Room A was conducted. Observation of Room A showed a five-bed room occupied by five residents.

On 4/28/25 at 1025 hours, an interview was conducted with the Administrator. The Administrator stated Room A had a total of 392 square feet and when occupied by five residents, each resident would have 78.4 square foot of space. The Administrator acknowledged the residents should have 80 square foot of space and verified the residents in Room A did not. The Administrator verbalized the facility would like to continue with the room variance waiver for Room A.

Cross reference to