Hyde Park Healthcare Center

F 0557 Level of Harm - Minimal harm or potential for actual harm

wheelchair. During a review of the facility's P&P titled, Residents' Personal Property, dated 12/2016, the P&P indicated any personal clothing or possessions retained by the facility for the resident during his or her stay should be identified and inventoried upon admission and the copy of inventory provided to the resident.

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

09/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Hyde Park Healthcare Center

6520 West Blvd.

Los Angeles, CA 90043

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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

provided razor for safety. CNA 1 stated the Ombudsman told her Resident 1 was being neglected. CNA 1 stated the Ombudsman asked her (CNA 1) about why Resident 1 was not being showered. CNA 1 stated

she told Ombudsman it was because Resident 1 was afraid to get in the Hoyer Lift (mechanical device, also called a patient lift, used to safely lift and transfer individuals with limited mobility). CNA 1 stated Resident 1 received bed-baths on Tuesday and Fridays, but the Ombudsman kept insisting Resident 1 was neglected.

CNA 1 stated that Ombudsman was on the phone with someone (unidentified) screaming it was resident neglect. CNA 1 stated the AADM told her the Ombudsman reported her for neglect. CNA 1 stated the AADM told her (CNA 1) that the AADM did not think she (CNA 1) did any neglect. CNA 1 stated that she (CNA 1) had to be suspended until he spoke with Department of Public Health (DPH). CNA 1 stated she was not suspended for neglect; she was suspended for customer service. CNA 1 stated the AADM told her,

she could return to work today (9/10/2025) but then called back and told her she could not go back to work until the investigation was complete. During a review of the facility's Policies and Procedures (P&P) titled Abuse and Neglect Prohibition Policy, dated 6/2022, the P&P indicated upon receiving information concerning a report of suspected neglect, the Administrator or designee should report all alleged violations immediately, but not later than 2 hours if the alleged violation involves abuse, using the SOC 341, to the Licensing and Certification Program District Office.

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

09/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Hyde Park Healthcare Center

6520 West Blvd.

Los Angeles, CA 90043

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 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

documented given at 7:28 p.m.5. On 8/28/2025, the Tamsulosin scheduled for 9:00 a.m. was documented given at 12:03 p.m.On 8/30/2025, the Tamsulosin scheduled for 9:00 a.m. was documented given at 12:01 p.m.On 9/1/2025, the Tamsulosin scheduled for 9:00 a.m. was documented given at 11:21 a.m.On 9/6/2025, the Tamsulosin scheduled for 9:00 a.m. was documented given at 11:55 a.m.On 9/8/2025, the Tamsulosin scheduled for 9:00 a.m. was documented given at 11:10 a.m.6. On 8/30/2025, the Metformin scheduled for 5:00 p.m., was documented given at 7:25 p.m.,On 9/1/2025, the Metformin scheduled for 7 a.m., was documented given at 11:21 a.m.7. On 8/30/2025, the Bimatoprost scheduled for 5:00 p.m. was documented given at 7:26 p.m.The DON stated Resident 1's Administration Details Record indicated the medications (Keppra, Clonidine, Hydralazine, Coreg, Tamsulosin and Metformin) were all given late. The DON stated it was important to administer all of Resident 1's medications on time because, if not, the medications will not be effective. The DON stated that not giving Resident 1 his BPH medicine on time could lead to difficulty in urination and discomfort. The DON stated HTN medications scheduled more than twice a day should be given as scheduled, because when given late and close to the next dose, could lead to double dosing causing the blood pressure to drop low and possibly lead to hospitalization. The DON stated it was very important to administer the seizure medication on time to prevent additional seizures, which could lead to hospitalizations.During a review of the facility's P&P titled Pharmaceutical Services Policy and Procedure Manual, dated 3/2022, the P&P indicated medications should be administered in accordance with good nursing principles and practices. The P&P indicated medications should be administered in accordance with written orders of the attending physician and should be administered within 60 minutes of scheduled time.

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

09/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Hyde Park Healthcare Center

6520 West Blvd.

Los Angeles, CA 90043

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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Medihoney (medical grade honey used to treat wounds) to wound bed and cover with dressing every day shift for 14 days. During an observation on 9/10/2025 at 10:25 a.m. with Treatment Nurse (TN) for Resident 1's wound care, Resident 1's bedside table was observed (while standing from the foot of the bed as requested by Resident 1) had two (2) water cups, 2 open straws, tissues, an open box of cereal, remote control and cell phone, opened clean dressing, gloves, wet gauze inside a clear plastic cup, ointment (unidentified) in a clear plastic cup and a white spray bottle (contents not identified). The TN was observed came in to the room and put on a pair of gloves. The TN asked the Certified Nurse Assistant (CNA) 4 to get

a trash bag. CNA 4 left the room and returned with a trash bag, put on her pair of gloves and turn Resident 1 to his left side. The TN removed Resident 1's dirty dressings on the buttocks area (sites not visible) and threw the dirty dressing into the trash bag that was hung on Resident 1's left side rail. The TN cleansed the buttocks area using the white spray bottle (contents not identified) that was on the table. The TN pat dried

the buttocks (site not visible), applied ointment that was in the clear plastic cup (name of ointment unidentified), and applied the dressing. TN and CNA 4 repositioned Resident 1 flat the bed. CNA 4 handed

the TN the trash bag containing dirty wound dressing supplies and placed the trash bag on Resident 1's bedside table. The TN covered Resident 1 with his blanket and then removed her gloves and threw them into the trash bag. The TN removed the trash bag from the bedside table and threw the trash bag inside the trash can. The TN moved the bedside table in front of Resident 1 and left the room without cleaning the bedside table. During an interview on 9/10/2025 at 11:00 a.m. with TN, the TN stated wound treatment should be done using clean technique (basic wound care hygiene and proper handwashing). The TN stated prior to the wound care, she should have introduced herself to the resident, got a bedside table and cleaned it, removed all personal items, draped the table then place the clean wound care supplies. The TN stated she did not remove Resident 1's personal items on the bedside table because Resident 1 did not want his personal items removed. The TN stated her dirty gloves were not removed throughout the wound care treatment because she had forgotten. The TN stated the bedside table was not cleaned after the dirty trash bag was removed on the bedside table because she forgot. The TN stated not following clean technique could lead to cross contamination, spread of germs leading to infections. During an interview on 9/10/2025 at 12:01 p.m. with CNA 4, CNA 4 stated she did not sanitize her hands prior to entering Resident 1's room and prior to turning Resident 1. CNA 4 stated she should have sanitized her hands to prevent the spread of germs. During a review of the facility's P&P titled, Clean Dressing Change, dated 4/2015, the P&P indicated licensed nurses should apply dressing using clean technique to promote wound healing and prevent cross-contamination among and between residents and caregivers. The P&P indicated to clean the work surface, wash hands, put on gloves, remove soiled dressing and gloves, place in bag for disposal, wash hands, put on clean gloves, clean wound as ordered, carefully dry wound, remove gloves, wash hands, put on clean gloves, apply dressing, remove gloves place in bag for disposal, wash hands, return resident to comfortable position with call button in reach and follow standard precautions at all times. During

a review of the facility's P&P titled, Scope of Infection Control Program, dated 6/29/2022, the P&P indicated standard precaution should be followed to prevent the spread of infections. The P&P indicated hand hygiene procedures should be followed by staff involved in direct resident contact.

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

09/11/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Hyde Park Healthcare Center

6520 West Blvd.

Los Angeles, CA 90043

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 0919 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

desperation because he could not get assistance in a timely manner. Resident 4 stated he was very thirsty and wanted something to drink. At 3:46 p.m. Resident 4 stated he could not wait any longer and he needed someone right away. CNA 5 was observed walking by Resident 4's room and was called for assistance.

CNA 5 was in a rush. CNA 5 was directed to ask what assistance Resident 4 needed. After CNA 5 asked Resident 4 what he needed, CNA 5 walked out of the room in a rush, came back and rushed to leave Resident 4's room. CNA 5 stated he was trying to get the charge nurse and did not notice the call light.

CNA 5 stated all call lights should be answered even if they were not their assigned rooms in case the situation was urgent. CNA 5 stated Resident 4 could have fallen attempting to get the attention of someone for assistance. During a review of the facility's Policy and Procedure (P&P) titled, Answering Call Lights, dated 8/2017, the P&P indicated residents' call lights should be answered as soon as possible, The P&P indicated staff should identify self when answering call light as needed and listen to the request. Requests should be fulfilled, if request cannot be fulfilled at the time of call light being answered, consider reporting and asking the charge nurse or supervisor or department manager for assistance. The P&P indicated staff should report all defective call lights.

Event ID:

Facility ID:

If continuation sheet