Buena Park Nursing Center
Inspection Findings
F-Tag F0552
F 0552
On 10/30/25 at 1553 hours, an interview was conducted with the DON. The DON acknowledged and verified the above findings.
Level of Harm - Potential for minimal harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 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
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
11/03/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Buena Park Nursing Center
8520 Western Avenue Buena Park, CA 90620
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-Tag F0656
F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews, medical record review, and facility document review, the facility failed to develop an individualized care plan for one of five sampled resident (Resident 1). *The facility failed to ensure a care plan was developed for Resident 1's Actual Fall Incident on 11/22/24. This failure posed the risk of not providing the appropriate and individualized care to Resident 1 to prevent another episode of fall.Findings:
Review of the facility's P&P titled Comprehensive Care Planning revised 3/2019 showed the plan of care must include measurable objectives and timeframes and describe the services that are to be furnished to attain and maintain the resident's highest practicable level of well-being. Closed medical record review for Resident 1 was initiated on 10/23/25. Resident 1 was admitted to the facility on [DATE REDACTED], and was discharged to the acute care hospital on 3/2/25. Review of Resident 1's H&P examination dated 10/14/24, showed Resident 1 had no capacity to understand and make decisions. Review of Resident 1's Licensed Nurses Progress Note dated 11/22/24, showed Resident 1 was found on the right side of bed on floor and
on side lying position. Review of Resident 1's Plan of Care failed to show a care plan problem was developed to address Resident 1's actual fall. On 10/30/25 at 1022 hours, an interview and concurrent medical record review for Resident 1 was conducted with RN 1. RN 1 reviewed Resident 1's Resident Care Plan and verified there was no care plan problem to address Resident 1's actual fall on 11/22/24. On 10/30/25 at 1553 hours, an interview and concurrent medical record review for Resident 1 was conducted with the DON. When the DON was asked about the process when a resident had a fall incident, the DON stated it was the responsibility of the licensed nurse to do the change of condition and care plan should be completed with each change of condition for the resident. The DON acknowledged and verified the above findings.
Event ID:
Facility ID:
If continuation sheet
Printed: 04/13/2026 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
B. Wing
A. Building
(X3) DATE SURVEY COMPLETED
11/03/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Buena Park Nursing Center
8520 Western Avenue Buena Park, CA 90620
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-Tag F0684
F 0684 Level of Harm - Minimal harm or potential for actual harm
On 10/30/25 at 1300 hours, an interview and concurrent medical record review for Resident 2 was conducted with RN 1. RN 1 verified the above findings. RN 1 verified a neurological check was not initiated
after Resident 2's fall on 10/1/25. RN 1 stated neurological checks were done for 72 hours status post fall and were done to monitor for changes in the resident's level of consciousness and for neurological changes.
Residents Affected - Few
On 10/30/25 at 1623 hours, an interview and concurrent medical record review for Resident 2 was conducted with the DON. The DON verified Resident 2 had an unwitnessed fall on 10/1/25. The DON stated Resident 2 should have had a neurological check for 72 hours status post unwitnessed fall. The DON further stated that neurological check allowed the nurses to assess for significant changes to the resident, which may indicate a head injury where the physician will need to be notified immediately.
On 10/31/25 at 1615 hours, an interview was conducted with the DON. The DON acknowledged and verified the above findings.
FORM CMS-2567 (02/99) Previous Versions Obsolete
Event ID:
Facility ID:
If continuation sheet
BUENA PARK NURSING CENTER in BUENA PARK, CA inspection on recent inspection.
Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.
Frequently Asked Questions
- What is an F-tag violation?
- F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
- Were these violations corrected?
- Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
- How often do nursing home inspections happen?
- CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
- What should families do about these violations?
- Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in BUENA PARK, CA, (5) Report new concerns to state authorities.
- Where can I see the full inspection report?
- Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from BUENA PARK NURSING CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.