Garden Grove Post Acute
Inspection Findings
F-Tag F0558
F 0558
Reasonably accommodate the needs and preferences of each resident.
Level of Harm - Potential for minimal harm
**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 provide the reasonable accommodations to meet the needs for one of seven sampled residents (Resident 4). * The facility failed to ensure Resident 4's call light was within the resident's reach. This failure had the potential to negatively impact the residents' physical and psychosocial well-being or result in a delay to receive care.Findings: Review of the facility's P&P titled Call Lights revised on January 2017 showed it is the policy of the facility to respond to the resident's request and needs. When the resident is in bed or in the wheelchair or chair in the room, staff should make sure the call light was within easy reach of the resident.
Medical record review for Resident 4 was initiated on 8/26/25. Resident 4 was admitted to the facility on [DATE REDACTED]. Review of Resident 4's MDS Quarterly assessment dated [DATE REDACTED], showed the resident had clear speech. Resident 4 could sometimes make themselves understood and sometimes was able to understand others. Resident 4 had a limitation in the range of motion to both upper extremities. Review of Resident 4's H&P examination dated 6/8/25, showed the resident could make their needs known but could not make medical decisions. Review of Resident 4's care plan dated 6/27/25, showed the resident had an actual fall with approaches/ intervention to place call light within reach. On 8/26/25 at 1400 hours, during an
observation, Resident 4 was lying in bed. The call light was clipped at the right corner of the mattress by the head of the bed, and the call light cord was dangling off the resident's bed. The resident's call light was not within reach. On 8/26/25 at 1550 hours, during an observation, Resident 4 was lying in bed. The call light was still clipped at the right corner of the mattress by the head of the bed, and was not within the resident's reach. On 8/26/25 at 1554 hours, an observation of Resident 4 and concurrent interview was conducted with CNA 6. CNA 6 verified the resident's call light was not within reach for the resident to use and was clipped by Resident 4's right corner of the mattress by the head of the bed. CNA 6 stated Resident 4 had
the ability to use call light when needing assistance. CNA 6 repositioned the call light within Resident 4's reach. On 8/26/25 at 1645 hours, an interview was conducted with the DON. The DON stated she expected
the staff to make sure the resident's call lights were always within the resident's reach at all times. Cross reference F-F689.
Residents Affected - Some
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
08/28/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Garden Grove Post Acute
12882 Shackelford Lane Garden Grove, CA 92841
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
resident was not compliant therefore the split was not provided. On 8/27/25 at 1446 hours, an interview was conducted with LVN 1. LVN 1 stated resident had episodes of removing the splint. LVN 1 further stated she and the treatment nurse had just applied the splint to the resident few minutes ago. On 8/28/25 at 1445 hours, an interview was conducted with the DON. The DON was informed and acknowledged the findings.
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
08/28/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Garden Grove Post Acute
12882 Shackelford Lane Garden Grove, CA 92841
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 F0689
F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
she informed LVN 3 of the incident. On 8/27/25 at 1140 hours, an interview and a concurrent medical
record review was conducted with the DON. The DON stated the floor mattress sed to prevent injury. The DON further stated a resident who was found on the floor mattress is considered a fall incident and the Fall policy should be followed. The DON stated she did not know Resident 4 was found on the floor mattress by
the SSD on 8/6/25. The DON verified Resident 4's medical record failed to show an assessment of the resident was conducted, and the physician and the family member were notified of the resident's fall on 8/6/25. On 8/27/25 at 1516 hours, an interview was conducted with LVN 3. LVN 3 verified the SSD informed him of Resident 4 was found on the floor mattress on 8/6/25. LVN 3 stated he did not thought of it as a fall because resident was found on the floor mattress. LVN 3 stated he did not initiate to call the physician and
the resident's family member. On 8/28/25 at 1445 hours, an interview was conducted with the DON. The DON was informed and acknowledged the findings as above.
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
08/28/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
Garden Grove Post Acute
12882 Shackelford Lane Garden Grove, CA 92841
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 F0693
Federal health inspectors cited GARDEN GROVE POST ACUTE in GARDEN GROVE, CA for a deficiency under regulatory tag F-F0693 during a complaint investigation conducted on 2025-08-28.
Category: Quality of Life and Care Deficiencies
The facility was found deficient in the following area: Ensure that feeding tubes are not used unless there is a medical reason and the resident agrees; and provide appropriate care for a resident with a feeding tube.
Scope/Severity Level D: isolated, no actual harm with potential for more than minimal harm.
While no actual harm was documented, there was potential for more than minimal harm to residents.
This was one of 4 deficiencies cited during this inspection of GARDEN GROVE POST ACUTE.
Correction Status: Deficient, Provider has date of correction.
The facility reported correction as of 2025-09-15.
GARDEN GROVE POST ACUTE in GARDEN GROVE, 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 GARDEN GROVE, 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 GARDEN GROVE POST ACUTE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.