Alcott Rehabilitation Hospital

F 0551

Give the resident's representative the ability to exercise the resident's rights.

Level of Harm - Minimal harm or potential for actual harm

Based on interview and record review, the facility failed to maintain the rights exercised by the resident's representative (RP) for one of three sampled residents (Resident 1). For Resident 1, the facility failed to obtain consent from Resident 1's responsible party (RP) before cutting Resident 1's hair on 12/9/25.This deficient practice resulted in a violation of Resident 1's RP's right to make decisions on behalf of Resident 1.During a review of Resident 1's admission Record, indicated the facility admitted Resident 1 on 11/21/25 with diagnoses including dementia (a progressive state of decline in mental abilities) fracture of right femur (break in thigh bone), lack of coordination, and dysphagia (difficulty swallowing).During a review of the Minimum Data Set (MDS - a resident assessment tool) dated 11/26/25 indicated Resident 1 had severely impaired cognitive skills for daily decision making. Resident 1 was dependent on staff for toileting hygiene, shower/bathe, lower body dressing and putting on/taking off footwear. Resident 1 needed substantial assistance (helper does more than half the effort) with eating, oral hygiene, upper body dressing and personal hygiene. During a review of Resident 1's History and Physical (H&P, a description of the resident's condition and course of care) dated 11/26/25 indicated Resident 1 does not have the capacity to understand and make decisions. During a telephone interview on 12/15/25 at 1:51 p.m., Resident 1's RP stated the facility gave Resident 1 a haircut on 12/9/25. Resident 1's RP stated she did not give consent for Resident 1 to have a haircut. During an interview on 12/23/25 at 8:42 a.m., the Activities Director (AD) stated the facility's hairdresser gave Resident 1 a haircut on 12/9/25. AD stated a consent was not obtained from Resident 1's RP before cutting Resident 1's hair on 12/9/25. AD stated, It was a mistake, sorry about that. AD stated facility needs to get consent from Resident 1's RP before cutting Resident 1's hair. During

an interview on 12/23/25 at 11:33 a.m., the Social Services Designee (SSD) stated Resident 1's RP did not give consent before Resident 1 was given a haircut on 12/9/25. During a review of the facility's policy and procedure (P&P) titled, Resident's Rights, revised on 5/2/25 indicated the resident representative has the right to exercise the resident's right to the extent those rights are delegated to the resident representative.

The same Policy indicated the resident had the right to be informed in advance of the care to be furnished and the type of care giver or professional that will furnish the care.

Residents Affected - Few

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

12/23/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Alcott Rehabilitation Hospital

3551 West Olympic Blvd.

Los Angeles, CA 90019

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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

Resident 2 needed substantial assistance with eating. During observation on 12/23/25 at 7:25 a.m.

Resident 2's breakfast tray was observed on top of Resident 2's bedside table located at the foot of her bed.During an interview on 12/23/25 at 7:48 a.m., CNA 2 stated she has three residents to feed including Resident 2. CNA 2 stated she has two other residents to feed before Resident 2's turn. During an interview

on 12/23/25 at 8:02 a.m., the restorative nursing assistant (RNA) stated breakfast trays were delivered from

the kitchen at around 7 a.m., and the trays are passed to the residents as soon as the trays arrived. RNA stated Resident 2 was a feeder (physical assistance with feeding). RNA stated Resident 2 should be fed as soon as the breakfast tray was taken to Resident 2. RNA stated if the tray is left too long on the bedside table, the food can get cold.During observation, CNA 2 was observed feeding Resident 2. During an

interview on 12/23/25 at 8:11 a.m., CNA 3 stated three residents to feed during mealtimes would be too much. CNA 3 stated the three residents had to wait a bit longer to be fed. During an interview on 12/23/25 at 9:56 a.m., the ADON stated Resident 2 was a feeder. ADON stated if the food is left on the table too long, the food can get cold.During a review of the facility's policy and procedure (P&P) titled, Resident Showers, revised on 5/2/25 indicated, It is the practice of this facility to assist residents with bathing to maintain proper hygiene, stimulate circulation and help prevent skin issues as per current standards of practice. The same Policy indicated residents will be provided showers as per request or as per facility schedule protocols and based upon resident safety. During a review of the facility P&P titled Documentation

in Medical Record revised on 5/2/25 indicated each resident's medical record shall contain a representation of the experiences of the resident and include enough information to provide a picture of the resident's progress. During a review of the facility's P&P titled Resident Rights revised on 5/2/25 indicated the resident has a right to a safe, clean, comfortable and homelike environment including but not limited to receiving treatment and supports for daily living.

Event ID:

Facility ID:

If continuation sheet