Villa Serena Healthcare Center
Inspection Findings
F-Tag F0684
F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few
FORM CMS-2567 (02/99) Previous Versions Obsolete
Resident 1 having rapid respirations (abnormally fast breathing greater than 20 breaths per minute) but hypoxia (when the body's tissues don't get enough oxygen) but presented with bilateral expiratory (exhale) wheezing (a high-pitched, whistling sound heard when a person breathes out) and tachycardia (abnormally fast heart rate greater than 100 beats per minute). The 911 Incident Report indicated paramedics were provided with a POLST for selective treatment that was incomplete and unsigned, and paramedics were unable to get a hold of FM 1 to clarify Resident 1's wishes, and as a result, Resident 1 was transferred to a General Acute Care Hospital (GACH).During an interview on [DATE REDACTED] at 11:31 a.m., the Director of Nursing (DON) stated it was important for Resident 1's POLST dated [DATE REDACTED] to be signed because it would be what
the paramedics will follow with a change of condition, and since it has changed from comfort measures to selective treatment.During an interview on [DATE REDACTED] at 12:06 p.m., with the Medical Records Director (MRD),
the MRD stated she believed she obtained the signature for Resident 1's POLST dated [DATE REDACTED] on [DATE REDACTED], and it was backdated. The MRD stated the POLST form should be signed by the physician as soon as possible, and no later than 72-hours.During an interview on [DATE REDACTED] at 12:55 p.m., with the Social Services Director (SSD), the SSD stated on [DATE REDACTED] she spoke to FM 1 regarding her desire to change Resident 1's POLST from comfort measures to selective measures, and it should have been signed that day by the physician to be acted upon, but she was not sure why it was not signed. During review of facility's policy and procedure (P&P) titled Physician Orders for Life Sustaining Treatment (POLST), dated [DATE REDACTED], the P&P indicated the purpose of the P&P was to help ensure the facility honors residents' treatment wishes concerning resuscitation and life-sustaining treatment. The P&P indicated for the POLST form to be valid, it must be signed by a physician, a nurse practitioner, or a physician assistant acting under the supervision of
the physician. The P&P indicated a Licensed Nurse or Social Service Designee must ensure the new POLST form is signed by the physician, and the resident, and the revoked POLST form is voided.
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VILLA SERENA HEALTHCARE CENTER in LONG BEACH, 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 LONG BEACH, 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 VILLA SERENA HEALTHCARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.