Hollywood Premier Healthcare Center

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

with LVN2, LVN2 stated she (LVN2) saw Resident 2 masturbating inside his room in his bed on 9/4/2025 (time unidentified) during the 7-3 pm shift with the privacy curtains open. During an interview and a record

review of Resident 2's medical chart (in general) on 9/9/2025 at 10:07AM, with the Social Services Director (SSD), the SSD stated the facility did not conduct an interdisciplinary team meeting (IDT, a collaborative group of diverse health care professionals from different fields who work together) to address Resident 2's inappropriate sexual behavior of walking around with his penis out and masturbating. The SSD stated the facility should have conducted an IDT to discuss Resident 2's inappropriate sexual behaviors to have better interventions. During an interview on 9/9/2025 at 12:45 PM with the DON, the DON stated she (DON) reviewed Resident 2's preadmission GACH1 record and that she (DON) was aware Resident 2 had a behavior of masturbation and that the facility would be able to care for Resident 2. The DON stated there was no IDT conducted. The DON stated there should have been an IDT to have interventions. The DON stated the Medical Director was notified on 9/9/2025 of Resident 1 and Resident 2's sexual abuse incident.

During an interview with the Medical Director on 9/9/2025 at 1:15PM, the Medical Director stated the DON notified him of Resident 1 and Resident 2 allegation of sexual abuse on 9/9/2025. The Medical Director stated the facility needed to conduct an IDT regarding Resident 2's behavior of inappropriate sexual behavior to have better interventions. During a review of the facility's Abuse, Neglect, Exploitation (means taking advantage of a resident for personal gain through the use of manipulation, intimidation, or threats), and Misappropriation Prevention Program, policy and procedure (P&P) dated April 2021 and reviewed 1/16/2025, the P&P indicated the residents have the right to be free from abuse including sexual abuse.

The P&P indicated the facility would protect residents from abuse, neglect .by anyone including, but not necessarily limited to . other residents. During a review of policy titled, Residents Rights dated 1/16/2025 indicated, Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to be free from abuse .

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

09/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Hollywood Premier Healthcare Center

5401 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 0607 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

10:07AM, with the Social Services Director (SSD), the SSD stated the facility did not conduct an interdisciplinary team meeting (IDT, a collaborative group of diverse health care professionals from different fields who work together) to address Resident 2's inappropriate sexual behavior of walking around with his genitals out and masturbating. The SSD stated the facility should have conducted an IDT to discuss Resident 2's inappropriate sexual behaviors to have better interventions. During an interview on 9/9/2025 at 12:45 PM with the DON, the DON stated she (DON) reviewed Resident 2's preadmission GACH1 record and that she (DON) was aware Resident 2 had a behavior of masturbation and that the facility would be able to care for Resident 2. The DON stated there was no IDT conducted. The DON stated there should have been an IDT to have interventions. The DON stated the Medical Director was notified on 9/9/2025 of Resident 1 and Resident 2's sexual abuse incident. During an interview with the Medical Director on 9/9/2025 at 1:15PM, the Medical Director stated the DON notified him of Resident 1 and Resident 2 allegation of sexual abuse on 9/9/2025. The Medical Director stated the facility needed to conduct an IDT regarding Resident 2's behavior of inappropriate sexual behavior to have better interventions. During an

interview with the ADM on 9/9/2025 at 1:38PM, the ADM stated the facility was responsible for knowing what type of residents (in general) would be admitted to the facility. The ADM stated he (ADM) was aware of Resident 2's behavior of masturbating and not of any other Resident 2's sexual behavior that was inappropriate. During a review of the facility's Abuse, Neglect, Exploitation (means taking advantage of a resident for personal gain through the use of manipulation, intimidation, or threats), and Misappropriation Prevention Program, policy and procedure (P&P) dated April 2021 and reviewed 1/16/2025, the P&P indicated the residents have the right to be free from abuse including sexual abuse. The P&P indicated the facility would protect residents from abuse, neglect .by anyone including, but not necessarily limited to . other residents. During a review of policy titled, Residents Rights dated 1/16/2025 indicated, Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to be free from abuse .

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

09/12/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Hollywood Premier Healthcare Center

5401 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 0943 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

company stated the abuse training would start after the state agency accepted the facility POC. The DON stated the POC had been accepted, however, the abuse training and monitoring that was supposed to start

the week of 10/19/2025 had not started, and that the third-party consultant nurse had done nothing. The DON stated, I can't think of the potential harm on the residents for not implementing resident-to-resident sexual abuse training. The DON further stated, Our Director of Staff Development (DSD) had in-serviced our staff. There is no difference between the clinical mentor (an experienced healthcare professional who guides and trains less experienced staff) we had and the outside agency nurse consultant. It was the same way that we provided the abuse training, so I do not see the potential for harm. During a concurrent

interview and concurrent record review on 10/29/2025 at 3PM with the DON, the facility's POC with a completion date of 10/9/2025 was reviewed. The DON confirmed and stated that the facility POC indicated

the facility will implement the following: 1. Develop and implement by the third party a monitoring tool to support weekly on-site (physical location) compliance (adherence to) observations.2. Clinical Auditing (examination) Tool by the third party used in charts(records) reviewed.3. Weekly on-site monitoring.4.

Reporting to California Department of Public Health the findings of weekly monitoring visits.5. Training materials and evaluation.6. Ongoing In-service training.7. Monthly Training Reports. The DON confirmed and stated the facility did not implement anything indicated on the POC. A review of the facility policy and procedures (P&P) titled, Abuse Prevention Program dated 1/16/2025, the P&P indicated, Our residents have the right to be free from abuse, neglect. This includes but is not limited to .verbal, mental, sexual or physical abuse. As part of the resident abuse prevention, the administration will: Require staff training/orientation programs that includes such topics as abuse prevention, identification and reporting abuse. and handling verbally or physically aggressive resident behavior.

Event ID:

Facility ID:

If continuation sheet