Canyon Oaks Nursing And Rehabilitation Center
Inspection Findings
F-Tag F0755
F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
hyperglycemic episode. During an interview on 8/25/2025 at 4:12 p.m., with Licensed Vocational Nurse 2 (LVN 2), LVN 2 stated that LVN 2 did not administer Resident 2's glargine insulin because LVN 2 overlooked
the parameters of the order. LVN 2 stated that she (LVN 2) should have read the order in its entirety. During
a review of the facility's policy and procedure (P&P) titled, Administering Medications, review date 1/15/2025, the policy indicated medications are administered in a safe and timely manner, and as prescribed. The director of nursing services supervises and directs all personnel who administer without unnecessary interruptions. Medications are administered in accordance with the prescriber orders, including any required time frame.
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
08/25/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Canyon Oaks Nursing and Rehabilitation Center
22029 Saticoy Street Canoga Park, CA 91303
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 F0803
F 0803
associated diseases.
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
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
08/25/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Canyon Oaks Nursing and Rehabilitation Center
22029 Saticoy Street Canoga Park, CA 91303
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 F0812
F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Based on observation, interview, and record review, the facility failed to follow proper food handling practices by failing to ensure clear storage cups of gelatin were dated and labeled according to the facility's policy.This deficient practice had the potential to place 142 out of 148 residents who receive food from the facility's kitchen at risk for foodborne illnesses (refers to illness caused by the ingestion of contaminated food or beverages). During an observation of the facility's kitchen refrigerator on 8/25/2025 at 1:45 p.m., observed open food items not in its original packaging and placed in clear storage cups. Observed several clear storage cups labeled SF and several clear storage cups with no labels. During a concurrent
observation and interview on 8/25/2025 at 1:46 p.m., with the Dietary Supervisor (DS), the DS stated that
the clear storage cups are cups of gelatine for the residents. Observed the DS count the clear storage cups. The DS stated 35 of the clear storage cups had no label and counted 11 clear storage cups labeled SF. The DS stated that SF meant sugar free and is served to residents with consistent carbohydrate diet (diet consistency that helps control blood sugar levels). The DS stated that when a food item is not in its original packaging, the food item must be labeled with the specific name of the food item and the date when
the food item was opened/prepared. When asked about the importance of accurate labeling, the DS stated that it is important to accurately label food items to make sure that the food item is what it is and for the safety of the residents. The DS further stated that the person preparing the gelatine is responsible for labeling. During a review of the facility's policy and procedure (P&P) titled, Food Safety Product Labeling & Dating Guide, review date 1/15/2025, the policy indicated under storing prepared food; Applies to: Purchased, ready-to-eat food removed from original container. Product storage label: Name of product, date of preparation and/or use-by date.
Event ID:
Facility ID:
If continuation sheet
CANYON OAKS NURSING AND REHABILITATION CENTER in CANOGA 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 CANOGA 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 CANYON OAKS NURSING AND REHABILITATION CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.