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Complaint Investigation

Pavilion On Pico Healthcare & Wellness Centre, Lp

March 26, 2025 · Los Angeles, CA · 5916 W. Pico Boulevard
Citations 4
CMS Rating 3/5
Beds 59
Provider ID 055160
Healthcare Facility
Pavilion On Pico Healthcare & Wellness Centre, Lp
Los Angeles, CA  ·  View full profile →
Source Document
Official CMS Inspection Report (Medicare.gov)
Downloaded from CMS/Medicare.gov. Reflects what state inspectors documented and does not include the facility's plan of correction, which is submitted separately. Facilities may have taken corrective actions since this report was released.
Inspection Summary

PAVILION ON PICO HEALTHCARE & WELLNESS CENTRE, LP in LOS ANGELES, CA — inspection on March 26, 2025.

Found 4 citations. Severity: Standard violations.

Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.

Inspection Findings

FF0624
Prepare residents for a safe transfer or discharge from the nursing home.

During a review of the facility's policy and procedure (P&P), titled, Discharge and Transfer of Residents, reviewed and approved by facility on 6/28/2024, the P&P indicated that, To ensure that discharge planning is complete and appropriate, and that necessary information is communicated to the continuing care provider .

The Facility may transfer or discharge a resident with an order from the resident's physician for: The discharge is necessary for the welfare of the resident, and needs cannot be met in the facility; The Resident's health has improved significantly and services provided by the facility are no longer required . A.

Prior to discharging the resident, Nursing Staff/IDT will prepare a Discharge Summary/Post Discharge Plan of Care and will document the summary in the resident's medical record.

During a review of the facility's P&P titled, Resident's Rights , reviewed and approved on 6/28/2024, the P&P indicated, The facility will promote and protect those rights.

Residents have freedom of choice, as much as possible, about how they wish to live their everyday lives and receive care, subject to the Facility's rules and regulations and applicable state and federal laws governing the protection of resident health and safety .

Employees are to treat all residents with kindness, respect, and dignity and honor the exercise of residents' rights.

055160 03/26/2025

Pavilion on Pico Healthcare & Wellness Centre, LP 5916 W.

Pico Boulevard Los Angeles, CA 90035

an in-house resident manifests a change in his/her mood or behavior symptoms, the licensed Nurse

055160 03/26/2025

Pavilion on Pico Healthcare & Wellness Centre, LP 5916 W.

Pico Boulevard Los Angeles, CA 90035

· Adheres to company standards for resolving consumer concerns.

·Ensures that all consumer/ resident rights are protected.

During a review of the Minimum Data Set (MDS - resident assessment tool) dated 2/7/2025, indicated Resident 1's cognitive (mental action or process of acquiring knowledge and understanding) skills for daily decisions were mildly impaired.

The MDS indicated Resident 1 required maximal assistance to total dependent from staff for activities of daily living (ADLs- routine tasks/activities such as bathing, dressing and toileting a person performs daily to care for themselves).

The MDS also indicated, Resident 1 experienced moderate depression in half or more of the days while in the facility.

During a review of Resident 1's History and Physical (H&P) dated 2/2/2025, the H&P indicated, Resident 1 can understand and make own medical decisions.

During a review of Resident 1's Care Plan (CP) for mood problem related to major depression, initiated on 2/10/2025, the CP indicated a goal of, Resident (1) will have improved mood state happier, calmer appearance, no signs and symptoms (s/sx) of depression.

During a review of Resident 1's Medical Record as of 3/26/2025, there was no CP develop regarding Resident 1's behavior of unrealistic demands and requests.

055160

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 055160 B.

Wing 03/26/2025

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Pavilion on Pico Healthcare & Wellness Centre, LP 5916 W.

Pico Boulevard Los Angeles, CA 90035

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 LOS ANGELES, 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 PAVILION ON PICO HEALTHCARE & WELLNESS CENTRE, LP or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


More Reports

About This Inspection Report

Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.

Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.

Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.