Stoney Point Healthcare Center
Inspection Findings
F-Tag F0695
F 0695 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
review of Resident1's Progress Notes dated 8/30/2025, timed at 9:58 a.m., the Progress Notes indicated that on 8/30/2025 at 9:58 a.m. an order was received from Medical Doctor 1 (MD 1) to transfer Resident 1 to the hospital (GACH 1) via 911 (emergency telephone number for immediate assistance from police, fire or emergency medical services [EMS - refers to a system that provides immediate medical care to individuals experiencing medical emergencies]) for comfort measures. The Progress Notes indicated that
on 8/30/2025 at 9:30 a.m., paramedics arrived and took over resident care. The Progress Notes indicated that on 8/30/2025 at 9:58 a.m., Resident 1 left the facility and was transferred to GACH 1. During a concurrent interview and record review on 9/5/2025 at 4:07 p.m., with the Director of Nursing (DON), Resident 1's Progress Note dated 8/30/2025 timed at 9:58 a.m. was reviewed. The DON stated that there was no documented evidence found in Resident 1's medical records indicating that oxygen flow rates (refers to the volume of supplemental oxygen delivered to a patient, measured in LPM) were increased to address Resident 1's oxygen saturation level of 80% on 8/30/2025 at 9:20 a.m., or that high concentration oxygen tank was administered using a non-rebreather mask (a single-use medical device that delivers a high concentration of oxygen to a patient with moderate to severe shortness of breath, with a typical oxygen flow rate of 10 to 15 LPM) prior to the arrival of paramedics. During a phone interview on 9/8/2025 at 10:12 a.m., with Registered Nurse 1 (RN 1), RN 1 stated that on 8/30/2025 at 9:20 a.m. Resident 1 was receiving oxygen at five (5) LPM via NC until paramedics arrived. RN 1 further stated that Resident 1 was not administered high concentration supplemental oxygen via a non-rebreather mask prior to the paramedics' arrival. During a review of Resident 1's Paramedics Patient Care Report dated 8/30/2025, the Paramedics Patient Care Report indicated that on 8/30/2025 the paramedics arrived on scene (at the facility) at 9:42 a.m. and found Resident 1 with an oxygen saturation level of 83% on four (4) LPM via nasal cannula, heart rate of 122 beats per minute and respiratory rate of 41 breaths per minute. The Paramedics Patient Care Report indicated that when facility staff (staff not indicated) was asked why Resident 1 wasn't placed on oxygen therapy no answer was given. The Paramedics Patient Care Report indicated Resident 1 was then placed on oxygen at 15 LPM via non-rebreather mask and given fluids for hypotension (low blood pressure). During a review of the facility's policy and procedure titled, Oxygen Administration, last reviewed
on 1/21/2025, the P&P indicated, The purpose of the procedure is to provide guidelines for safe oxygen administration. Adjust the oxygen delivery device so that it is comfortable for the resident and the proper flow of oxygen is being administered. Documentation: After completing the oxygen setup or adjustment, the following information should be recorded in the resident's medical record. The rate of oxygen flow, route, and rationale. All assessment data obtained before, during, and after the procedure.
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STONEY POINT HEALTHCARE CENTER in CHATSWORTH, 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 CHATSWORTH, 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 STONEY POINT HEALTHCARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.