Colonial Care Center

During a review of the facility's policy and procedure (P/P) titled, Quality Assurance and Performance (QAPI) Program, revised ,d+[DATE], indicated the facility implements and maintains an ongoing, facility-wide Quality Assurance and Performance Improvement (QAPI) Program focused on the indicators of the outcomes of care and quality of life for our residents.

The P/P indicated the objective of the QAPI program was to provide a means to measure current and potential indicators for outcomes of care and quality of life and establish a system through which to monitor and evaluate corrective actions.

056043

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 056043 B.

Wing 02/06/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Colonial Care Center 1913 E 5th Street Long Beach, CA 90802

During a review of Resident 188's Minimum Data Set ([MDS] a resident assessment tool) dated 12/13/2024, the MDS indicated Resident 188 had severe cognitive impairment (a significant decline in cognitive abilities that significantly impact daily functioning and independence) for daily decision making.

The MDS indicated Resident 188's current weight as of 12/6/2024 was 119 lbs.

The MDS indicated Resident 188 was receiving a therapeutic (a meal plan that controls the intake of certain foods or nutrients) diet and was receiving 51% or more of his total calories through a feeding tube.

During a review of Resident 188's untitled Care Plan initiated on 12/23/2024, the Care Plan indicated Resident 188 had cancer with an increased risk for weight loss secondary to non-Hodgkin's lymphoma.

The untitled Care Plan indicated Resident 188's goal was not to have a weight loss exceeding 5% per month.

The Care Plan interventions included RD evaluations and to notify the physician and Resident 188's responsible party of any change of conditions.

During a review of a document titled, Weekly-Weights- Station Subacute (a level of care needed by a patient who does not require hospital level acute care but who requires more intensive licensed skilled nursing care than is provided to the majority of patients in a skilled nursing facility) Summary dated 12/2024, the document indicated Resident 188's admitting weight was 119 lbs. and was weighed weekly after admission on 12/6/2024. Resident 188's weight was as follows:

1. On 12/11/2024 Resident 188's weight was 115 lbs.

There was four lbs. weight loss in five days since admission on12/6/2024.

2. On 12/18/2024 Resident 188's weight was 112 lbs.

There was another three lbs. weight loss in a week from 12/11/2024.

3. On 12/27/2024 Resident 188's weight was 110 lbs.

There was another two lbs. weight loss in a week from 12/28/2024.

4. On 1/3/2025 Resident 188's weight was 110 lbs.

The Weekly Weights and Vitals Summary did not indicate the aforementioned weekly weights were recorded and addressed in Resident 188's electronic medical record (EMR) and the resident's weekly weight loss was addressed.

056043

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 056043 B.

Wing 02/06/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Colonial Care Center 1913 E 5th Street Long Beach, CA 90802