Rosecrans Care Center
Inspection Findings
F-Tag F0550
F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some
FORM CMS-2567 (02/99) Previous Versions Obsolete
facility admitted Resident 4 on 10/4/2023 with diagnoses including epilepsy, generalized muscle weakness, dementia, hemiplegia (total paralysis ofthe arm, leg, and trunk on the same side of the body), hemiparesis (total paralysis of the arm, leg, and trunk on the same side of the body), and diabetes mellitus.During a
review of Resident 4's H&P, dated 1/26/2024, the H&P indicated, Resident 4 did not have the capacity to understand and make decisions.During a review of Resident 4's MDS, dated [DATE REDACTED] the MDS indicated Resident 4 had severe cognitive impairment. The MDS also indicated Resident 4 required maximum assistance for ADLs. During a concurrent observation and interview on 9/22/2025 at 9:57 a.m. in Resident 4's room, CNA 3 was providing ADLs to Resident 4. Resident 4 was observed with the entire body exposed. The privacy curtain was only halfway closed. CNA 3 was in the process of cleaning Resident 4 while the resident remained naked. CNA 3 stated curtains needed to be closed all the way to provide privacy. During an interview on 9/22/2025 at 12:16 p.m. with CNA 3, CNA 3 stated closing the curtain was important to provide privacy to Residents. CNA 3 stated residents would feel embarrassed, and uncomfortable if privacy were not provided to them.During an interview on 9/22/2025 at 1:05 p.m. with the Licensed Vocational Nurse (LVN) 1, LVN 1 stated providing privacy such as closing the doors, and curtains were important for respect and dignity purposes. LVN 1 stated residents would feel embarrassed if they were exposed during care. During an interview on 9/22/2025 at 2:45 p.m. with Registered Nurse (RN) 1, RN 1 stated to ensure residents' privacy, staff are expected to knock before entering, introduce themselves, close privacy curtains, and explain the procedures to be performed. RN 1 stated failing to close curtains
before providing care can affect a resident's dignity and make them feel embarrassed, which may affect the residents psychologically. During a review of the facility's Policy & Procedure (P&P) titled, Dignity, revised
on February 2021, the P&P indicated, Each resident shall be cared for in a manner that respects and enhances his or her sense of well-being, level of satisfaction with life, and feelings of self-worth and self-esteem .Staff promote, maintain and protect resident privacy, including bodily privacy during assistance with personal care and during treatment procedures. During a review of the facility's P&P titled, Residents Rights Guidelines for all Nursing Procedures, revised on October 2010, the P&P indicated, facility was to close the room entrance door and provide for the resident's privacy.
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ROSECRANS CARE CENTER in GARDENA, 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 GARDENA, 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 ROSECRANS CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.