Burbank Healthcare & Rehab

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Based on interview and record review, the facility failed to report an allegation of a misappropriation of resident property (the deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the resident's consent) of one of four sampled residents (Resident 4) to the State Survey Agency (SSA) when Family Member (FM) 1 allegedly took Resident 4's wallet and charged $500 on Resident 1's credit card. This deficient practice had the potential to place Resident 1 at increased risk for further abuse which could have led to additional unreported incidents and delay the SSA's ability to promptly investigate the allegation of a misappropriation of resident property.Findings:

During a review of Resident 4's admission Record (AR), the AR indicated the facility originally admitted Resident 4 on 1/10/2026 with diagnoses including muscle weakness and sepsis (a life-threatening medical emergency caused by the body's extreme response to infection). During a review of Resident 1's History and Physical (H&P), dated 1/11/2026, the H&P indicated Resident 4 had the capacity to understand and make decisions. During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool), dated 1/17/2026, the MDS indicated Resident 4 had intact cognitive functioning (the ability to think, learn, remember, use judgment, and make decisions). During an interview on 1/26/2025 at 11:15 a.m. with Resident 4, Resident 4 stated that FM 1 came to visit him (Resident 4), took his (Resident 4) wallet, left the facility, charged $500 to Resident 4's credit, and returned back to the facility to give him (Resident 4) back his wallet (with the credit card). Resident 4 stated he cannot remember the exact date and time of the incident. Resident 4 stated he reported the incident to the Social Worker (SW) but cannot remember the date and time he reported it to the SW. During an interview on 1/26/2026 at 1:30 p.m. with SW, the SW stated that Resident 4 reported to him (SW) that FM 1 took Resident 4's wallet and charged $500 to Resident 4's credit card (did not indicate the date and time). During an interview on 1/28/2026 at 2:30 p.m. with the Administrator, the Administrator stated Resident 4 informed the SW that FM 1 took Resident 4's wallet and charged $500 on Resident 4's credit card. The Administrator stated she did not report to the SSA Resident 4's allegation of a misappropriation of property. The Administrator stated she should have reported the incident to the SSA when it happens again in the future. During a review of the facility-provided policy and procedure (P&P) titled, Abuse, Neglect, Exploitation or Misappropriation-Reporting and Investigating, last reviewed on 8/15/2025, the P&P indicated, All reports of resident abuse, . theft/misappropriation of resident property are reported to local, state, and federal agencies (as required by current regulations). If resident abuse, . misappropriation of resident property . is suspected, the suspicion must be reported immediately to the administrator and to the other officials according to the state law. The Administrator or the individual making the allegation immediately reports his or her suspicion to the following persons or agencies: a. The State licensing/certification agency responsible for surveying/ licensing the facility. ‘Immediately' is defined as: a. within two hours of an allegation involving abuse .

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

01/31/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Burbank Healthcare & Rehab

1041 S. Main St.

Burbank, CA 91506

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 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

interview and record review, the facility failed to develop and implement a person-centered Care Plan (a plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial and functional needs) for one of three sampled residents (Resident 2) to address that Resident 2 was immunocompromised (having a weakened immune system that cannot fight infections and diseases as effectively as a healthy one) and had high risk for infection. This failure had the potential to delay provision of necessary care for Resident 2 and placed Resident 2 at risk of developing an infection. Findings:During a

review of Resident 2's Face Sheet, undated, the Face Sheet indicated the facility originally admitted Resident 2 on 6/20/2026 and readmitted on [DATE REDACTED], with diagnoses including diffuse large B-cell lymphoma (is a fast-growing, aggressive type of non-Hodgkin lymphoma [blood cancer] that develops when abnormal B-cell lymphocytes [a type of white blood cell] multiply uncontrollably and frequently causes swollen lymph nodes, fever, and weight loss, and can spread rapidly to other organs), encounter for antineoplastic chemotherapy (the use of medication designed to treat cancer by inhibiting or killing rapidly dividing malignant cells), and acquired absence of kidney. During a review of Resident 2's Minimum Data Set (MDS - a resident assessment tool), the MDS, dated [DATE REDACTED], the MDS indicated Resident 2's cognitive functioning was intact (the ability to think, learn, remember, use judgment, and make decisions). The MDS indicated Resident 2 needed substantial/maximal assistance (helper does more than half the effort with helper lifting or holding trunk or limbs and providing more than half the effort) with toileting hygiene, shower/bathe self, lower body dressing and putting on/taking off footwear. During a concurrent interview and record review on 1/30/2026 at 3:44 p.m. with the Director of Nursing (DON), Resident 2's Care Plans were reviewed. The DON stated the facility staff failed to initiate and implement a Care Plan for Resident 2 to address that Resident 2 was immunocompromised being diagnosed with diffuse large B-cell lymphoma. The DON stated

it was the responsibility of licensed staff or the MDS Coordinator to initiate the Care Plan when Resident 2 was admitted to facility. The DON stated Resident 2's Care Plan should have addressed that Resident 2 could not be cohorted (grouping residents together based on their infection status to prevent the spread of illness to healthy residents) with a resident who had an active infection. The DON stated the Care Plan was

a guide to implement the necessary interventions for Resident 2. The DON stated Resident 2's Care Plan was not comprehensive and person centered. The DON stated the failure to develop a comprehensive Care Plan that addressed Resident 2's immunocompromised status placed Resident 2 at risk of acquiring infection, which had the potential to lead to sepsis and other complications such as death. During a review of the facility-provided policy and procedure (P&P) titled, Care plans, Comprehensive Person-Centered, last revised on 8/15/2025, the P&P indicated, A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical and functional needs is developed and implemented for each resident. 3. The care plan interventions are derived from a thorough analysis of

the information gathered as part of the comprehensive assessment.7. The comprehensive, person-centered care plan: .b. describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being e. reflects currently recognized standards of practice for problem areas and conditions.

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

01/31/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Burbank Healthcare & Rehab

1041 S. Main St.

Burbank, CA 91506

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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

with diagnoses including other hypertrophic cardiomyopathy (a genetic condition where the heart muscle thickens but does not physically block blood flow out of the heart), chronic kidney disease (long-term, progressive loss of kidney function), type two DM, depression (is a serious, common medical illness characterized by a persistent low mood, sadness, or loss of interest in activities), and anxiety disorders (a group of common mental health conditions characterized by excessive, persistent, and uncontrollable fear or worry that interferes with daily life, work, or relationships). During a review of Resident 3's MDS, dated [DATE REDACTED], the MDS indicated Resident 3 had moderately impaired cognitive functioning. The MDS indicated Resident 3 needed substantial/maximal assistance with toileting hygiene, lower body dressing and putting on/taking off footwear.During a concurrent interview and record review on 1/30/2026 at 3:44 p.m. with the Director of Nursing (DON), Resident 2 and Resident 3's Care Plans were reviewed. The DON stated the facility staff failed to update Resident 2 and Resident 3's Care Plans when residents (Resident 2 and 3) were cohorted with Resident 1. The DON stated it was the responsibility of licensed staff and MDS Coordinator to update the Care Plans. The DON stated the Care Plans were guides to implement the necessary interventions for Resident 2 and Resident 3. The DON stated Resident 2 and Resident 3's Care Plans were not comprehensive and not person-centered. The DON stated the failure to revise the Care Plans had the potential to delay care for Resident 2 and Resident 3. The DON stated Resident 2 and Resident 3 were placed at risk of acquiring CDI, which had the potential to lead to sepsis and other complications such as death. During a review of the facility-provided policy and procedure (P&P) titled, Care plans, Comprehensive Person-Centered, last revised on 8/15/2025, the P&P indicated, A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical and functional needs is developed and implemented for each resident. 3. The care plan interventions are derived from a thorough analysis of the information gathered as part of the comprehensive assessment.7. The comprehensive, person-centered care plan: .b. describes the services that are to be furnished to attain or maintain the resident's highest practicable physical, mental, and psychosocial well-being e. reflects currently recognized standards of practice for problem areas and conditions.11. Assessments of residents are ongoing and care plans are revised as information about the residents and the resident's conditions change.

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

01/31/2026

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Burbank Healthcare & Rehab

1041 S. Main St.

Burbank, CA 91506

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 0880 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Residents 2 and 3 for signs and symptoms of CDI.During a review of the facility's P&P titled, Clostridium Difficile, with revised date of 10/2018 and last review date of 8/15/2025, the P&P indicated, Measures are taken to prevent the occurrence of Clostridium difficile infections (CDI) among residents. Precautions are taken while caring for residents with C. difficile to prevent transmissions to other residents. Residents considered at high risk of developing symptoms associated with C. difficile include those with: . antibiotic or anti-neoplastic therapy. The primary reservoir (any person, animal, plant, or substance where an infectious agent [germ] normally lives, grows and multiplies) for C. difficile are infected people and surfaces. Spores (are the dormant, highly resistant, and inactive form of the bacteria that survive for months on surfaces, resisting heat, alcohol-based hand sanitizers, and antibiotics) can persist on resident-care items and surfaces for several months and are resistant to some common cleaning and disinfection methods. C. difficile is transmitted via the fecal-oral route (transfer of bacteria from the feces of an infected person to the mouth of another person). Therefore, any resident-care activity that involves contact with the resident's mouth when hands or instruments are contaminated may provide an opportunity for transmission, for example: a. oral care . c. administration of oral medications . Residents with diarrhea associated with C. difficile (i.e., residents who are colonized and symptomatic) are placed on contact precautions. Residents with diarrhea and suspected CDI are placed on contact precautions while awaiting laboratory results.During

a review of the facility's P&P titled, Isolation - Categories of Transmission-Based Precautions, with revised date of 9/2022 and last review date of 8/15/2025, the P&P indicated, Transmission-based precautions are initiated when a resident develops signs and symptoms of a transmissible infection; . has a laboratory confirmed infection; and is at risk of transmitting the infection to other residents. The Centers for Disease Control and Prevention (CDC) maintains a list of diseases, modes of transmission and recommended precautions. Contact precautions are implemented for residents known or suspected to be infected with microorganisms that can be transmitted by direct contact with the resident or indirect contact with environmental surfaces or resident-care items in the resident's environment. Contact precautions are also used in situations when a resident is experiencing . diarrhea, . even before a specific organism has been identified. The individual on contact precaution is placed in a private room if possible. If a private room is not available, the infection preventionist will assess various risks associated with other resident placement options (e.g., cohorting, placing with a low risk roommate). Staff and visitors wear gloves (clean, non-sterile) when entering the room. Staff and visitors wear a disposable gown upon entering the room and remove before leaving the room.

Event ID:

Facility ID:

If continuation sheet