Fountain View Subacute And Nursing Center

F 0550 Level of Harm - Minimal harm or potential for actual harm

facility respond to his grievances. Residents have the right to a dignified existence, respect, kindness, self-determination, and communication with and access to people and services both inside and outside the facility.

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

12/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Fountain View Subacute and Nursing Center

5310 Fountain Ave Los Angeles, CA 90029

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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Coordinator and functions as a case manager. The CC stated the social worker from the facility was previously contacted, but there had been a change in personnel, and Resident 1 no longer received escort services. The CC stated the physician from the external clinic informed him that Resident 1 had missed appointments on 10/21/2025, 11/6/2025, 12/3/2025, and 12/23/2025. The CC stated he followed up with the facility, which indicated they were unaware of these appointments. The CC stated Resident 1 attended one appointment on 12/24/2025 but missed the CT (Computed Tomography- scan, uses X-rays and a computer to create detailed, cross-sectional images of the inside of your body, showing bones, organs, and soft tissues with much greater clarity than standard X-rays. It helps doctors diagnose diseases, plan treatments, guide procedures like biopsies, and monitor conditions such as tumors, injuries, and internal bleeding, often taking just minutes to perform) scan scheduled for 12/23/2025, and the other appointments scheduled for 10/21/2025, 11/6/2025, and 12/3/2025. During an interview on 12/ 29/2025 at 2:52 PM with the Director of Nursing (DON), the DON stated the process for ensuring residents attend their appointments involves following the doctor's orders. When residents return from outside clinics, they are given new orders or follow-up dates. The nurses then create an order, communicate among themselves, endorse, and hold a huddle. The expectation is that when residents return, they have progress notes from the doctor, follow-up appointments, or new orders. The DON mentioned that failure to document new orders and follow-up appointments delayed treatment for Resident 1, potentially causing health deterioration, unmet care needs, and a lack of quality of life.During an interview on 12/29/2025 at 3:05 PM with the Administrator, the Administrator stated the facility can send one of the Certified Nursing Assistants or Activity Staff to escort Resident 1 to his appointments. The Administrator mentioned lack of staff is not a reason to miss resident appointments. The Administrator stated that two social workers recently left. They hired the current SSW four months ago and are awaiting another hire to help manage the high workload.During a review of the facility's policy and procedures (P&P) titled Appointments, undated, the P&P indicated the facility will assist

in scheduling appointments and arranging transportation for residents to ensure they can attend their appointments. If needed, arrangements will be made for a resident to have someone accompany them to their appointment. Licensed nurses document resident's departure and clinical condition on the day of the appointment and when the resident comes back. Any new orders and follow-up appointments are documented in the electronic health record and follow-up availability of Medical Doctor progress notes is to be included in resident's medical record.

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

12/29/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Fountain View Subacute and Nursing Center

5310 Fountain Ave Los Angeles, CA 90029

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 0745

Provide medically-related social services to help each resident achieve the highest possible quality of life.

Level of Harm - Minimal harm or potential for actual harm

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on

observation, interview, and record review, the facility failed to ensure timely follow-up and communication with one of four sampled residents (Resident 2) regarding Resident 2's request to transfer to another facility. This failure resulted in Resident 2 experiencing frustration and dissatisfaction with communication and care and impeded Resident 2's request to transfer and maintain his highest practicable physical, mental and psychosocial well-being. During a review of Resident 2's admission Record, the admission

Record indicated Resident 2 was admitted to the facility on [DATE REDACTED] with diagnosis of heart failure (the heart muscle isn't pumping blood as well as it should, failing to meet the body's needs for oxygen and nutrients, leading to fluid buildup (swelling) and symptoms like shortness of breath and fatigue), obesity (excessive body fat), and reduced mobility. During a review of Resident 2's Minimum Data Set (MDS- a resident assessment tool) dated 2/8/2025, indicated Resident 2 had intact cognition (ability to think, remember and reason) for decisions of daily living, and required maximal assistance (Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) for eating, upper body dressing, oral hygiene, and personal hygiene. The MDS indicated Resident 2 was dependent (Helper does ALL of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity) on staff for toileting, lower body dressing, putting on/off footwear, showering, and rolling left and right. During a concurrent observation and interview

on 12/29/2025 at 12:31 PM in Resident 2' room, Resident 2 stated he was very upset because he requested assistance with transferring to a different facility and stated that he did not receive any updates regarding the status of his request for approximately one month. The resident verbalized frustration and concern due to the lack of communication and perceived lack of support with his care preferences.

Resident 2 stated he had stopped his physical therapy (PT) sessions to save his hours of PT for when he was transferred to the facility of his choice. During an interview on 12/29/2025 at 1:30 PM with the Social Services Worker (SSW), the SSW acknowledged that she failed to follow up on the Resident 2's request by contacting the requested receiving facility. The SSW further admitted that she did not provide Resident 2 with updates regarding the status of the transfer request during that period. Record review revealed no documentation indicating that the requested facility had been contacted or that Resident 2 had been informed of any progress or delays related to his request.During an interview on 12/29/2025 at 2:52 PM with the Director of Nursing (DON), the DON stated it is the responsibility of the SSW to assist residents in obtaining resolution to grievances, requests, and accommodation of needs by communicating with residents any updates regarding their concerns. The DON stated communicating with residents was important to maintain resident rights and quality of care.During a review of the facility's policy and procedures (P&P) titled Social Services, dated 9/2021, the P&P indicated the director of social services is responsible for assisting with the medically-related social service needs of residents including, situations that impede the resident's dignity and sense of control, helping residents with transitions of care services, advocating for and assisting residents rights and obtaining resolution to living conditions, grievances about treatment and accommodation of needs.

Residents Affected - Few

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

Event ID:

Facility ID:

If continuation sheet