Buena Park Nursing Center
Inspection Findings
F-Tag F0656
F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
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
observation, interview, medical record review and facility P&P review, the facility failed to ensure the care plan was followed for the use of restraints for one of six sampled residents (Resident 6). * The facility failed to ensure Resident 6's left hand mitten was released every two hours as per the care plan. This failure had
the potential to cause delays in identifying possible health risks associated with the use of hand mitten restraint including poor circulation and impaired skin integrity. Findings: Review of the facility's P&P titled Physical Restraints revised 1/2017 showed if the restraints are utilized, the opportunity for motion and exercise should be provided for a period of not less than 10 minutes during two hour period in which restraints are utilized. Medical record review for Resident 6 was initiated on 1/28/26. Resident 6 was admitted to the facility on [DATE REDACTED]. Review of Resident 6's Order Summary Report showed a physician's order dated 3/10/25, to apply left hand mitten necessity due to persistent pulling out of GT. Review of Resident 6's care plan for usage of the left hand mittens or persistent pulling out of GT initiated 3/10/25 and revised 11/9/25, showed interventions including the application of the left hand mitten to prevent pulling out
the tube and release every two hours for circulation and comfort for 15 minutes. Review of Resident 6's MAR for March 2025 showed the left hand mitten placement was monitored every shift on 3/10 - 3/31/25.
Review of Resident 6's medical record failed to show documented evidence Resident 6's left hand mitten restraint was released every two hours for skin integrity and circulation. On 1/30/26 at 1100 hours, an
interview and concurrent medical record review for Resident 6 was conducted with RN 1. RN 1 stated the facility protocol for the use of hand mitten restraint was to remove the hand mitten every two hours and check for circulation and skin condition. RN 1 verified Resident 6 did not have an order to monitor circulation and skin condition every 2 hours. RN 1 further verified there was no documentation to show whether Resident 6's hand mittens were released every two hours to monitor for circulation and comfort. On 1/30/26 at 1315 hours, an interview was conducted with the Administrator. The Administrator was informed and acknowledged the above findings.
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.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99) Previous Versions Obsolete
Facility ID:
If continuation sheet
Event ID:
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
01/30/2026
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 F0755
F 0755
and Administrator were informed and acknowledged the findings.
Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
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.