Sharon Care Center

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

FM 2 on 11/25/2025 at 3:06 pm, FM 1 stated that Resident 1 was in her usual state of health where she would helped up out of bed and sit in her wheelchair and socialize with other residents in the dining room, FM 1 stated that Resident gradually stopped and stayed in bed and was noted to have increased confusion.

FM 2 stated that the facility had not reached out to any family members for a meeting to discuss Resident 1's care or progress in over a year. FM 1 stated that the facility did not inform them that Resident 1 had pressure ulcers nor that she was refusing care. FM 1 stated that Resident was confused and unable to make decisions. FM 2 stated that the facility called her on 11/6/2025 for the first time to inform her that Resident 1 was refusing to eat and refusing to have an IV inserted to administer IV fluids to support her while she was refusing to eat. FM 1 stated that the facility called her on 11/7/2025 to inform her that Resident 1 was sent to GACH for poor oral intake. When FM 1 and FM 2 arrived at GACH, they were both shocked at Resident 1's condition as she appeared to be very skinny and had a wound to her sacrum which was very scary to look at it had reached the bone and were told that Resident 1 had infection from

the wound which had gone to her blood. During an interview with the DON on 11/26/2025 at 2:36 PM, the DON stated that when a resident consumes less than 50% of their meals the physician must be notified

after two to three meals. The DON Confirmed that Resident 1 consumed less than 50% of her meals on 10/28/2025 and progressively decreased several times after that but that the physician had not been notified about this COC. The DON Stated that it is important to notify the physician about decreased oral intakes for the resident's well-being and for improving PU outcomes. The DON Confirmed that reduced intake could result in dehydration. During a review of a policy and procedure (P&P) titled, Change in Condition: Notification of, reviewed 12/16/2024 indicated, To ensure residents, family, legal representatives, and physicians are informed of changes in the resident's condition. The same P&P indicated A Facility must immediately inform the resident, consult with the Resident's physician and/or NP, andnotify, consistent with his/her authority, Resident Representative where there is: An accident involving the Resident. A significant change in the Resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental or psychosocial status in either life-threatening conditions or clinical complications). A need to alter treatment significantly (that is, a need to discontinue or change an existing form of treatment due to adverse consequences, or to commence a new form of treatment); or A decision to transfer or discharge

the Resident from the Center. When making notification of above, the Facility must ensure that all pertinent information is available and provided upon request to the physician and/ or NP. During a review of a P&P titled, Physician Orders, reviewed on 12/16/2024 indicated, This will ensure that all physician orders are complete and accurate. The same P&P indicated, Whenever possible, the Licensed Nurse receiving the order will be responsible for documenting and implementing the order. Medication/treatment orders will be transcribed onto the appropriate resident administration record. Orders pertaining to other health care disciplines will be transcribed onto the appropriate communication system for that discipline. During a

review of a P&P titled, Resident Hydration and Prevention of Dehydration, reviewed 3/4/2025, indicated,

This facility will strive to provide adequate hydration and to prevent and treat dehydration. The same P&P indicated under Policy interpretation and implementation the following:- Nurses will assess for signs and symptoms of dehydration during daily care.- Laboratory tests may be ordered to assess hydration if intake and symptoms indicate possible significant dehydration.

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

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sharon Care Center

8167 West Third St.

Los Angeles, CA 90048

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 0657 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

sometimes fight and refuse to get Her incontinence briefs changed and remained soiled. CNA 1 stated that

on average she got Resident 1 changed at least twice per shift. CAN 1 stated that Resident 1 did not want food and would only drink coffee and eat about 25% of her meals. CNA 1 stated that she reported to the charged nurse. During an interview with the Registered Nurse (RN) 1 on 11/25/2025 at 11:40 am, RN 1 stated that the outgoing RN had endorsed to her (RN1) that Resident 1 had orders to insert an IV and fluid administration for decreased oral intake but that the orders had not been carried out because Resident 1 had refused. RN 1 confirmed that the orders for labs had also not been carried out and that there was no documented evidence that the physician or Resident 1's healthcare proxy (a trusted person you legally appoint to make medical decisions for you if you become unable to communicate or decide for yourself, ensuring your healthcare wishes are followed even in an emergency or serious illness ) had been informed about the refusal. During an interview with the DON on 11/26/2025 at 2:36 PM, the DON stated that when a resident consumes less than 50% of their meals the physician must be notified after two to three meals.

The DON Confirmed that Resident 1 consumed less than 50% of her meals on 10/28/2025 and progressively decreased several times after that but that the physician had not been notified about this COC. The DON confirmed that the orders for inserting IV, administering IV fluids, collecting labs for CBC, BMP, UA, C&S had not been carried out and that there was no documented evidence that the physician or

the healthcare proxy was notified. The DON confirmed that Resident 1's healthcare proxy and Resident 1 were not invited to any of the IDTs reviewed over the last year. During a review of the facility's policy and procedures (P&P) titled, Change in Condition: Notification of, reviewed 12/16/2024, the P&P indicated, To ensure residents, family, legal representatives, and physicians are informed of changes in the resident's condition. The same P&P indicated A Facility must immediately inform the resident, consult with the Resident's physician and/or NP, andnotify, consistent with his/her authority, Resident Representative where there is: An accident involving the Resident. A significant change in the Resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental or psychosocial status in either life-threatening conditions or clinical complications). A need to alter treatment significantly (that is, a need to discontinue or change an existing form of treatment due to adverse consequences, or to commence a new form of treatment); or A decision to transfer or discharge the Resident from the Center. When making notification of above, the Facility must ensure that all pertinent information is available and provided upon request to the physician and/ or NP. During a review of the facility's P&P titled, CARE PLANNING - INTERDISCIPLINARY TEAM, reviewed on 12/16/2024, indicated, Our facility's Interdisciplinary Team is responsible for the development of an individualized comprehensive care plan for each resident. The same P&P indicated the care plan is based on the resident's comprehensive assessments developed by the interdisciplinary team with included the following:1. The resident's Attending Physician. 2. A registered nurse with responsibility for

the resident. 3. The Dietary Manager/Dietitian. 4. The Social Services Worker responsible for the resident. 5.

The Activity Director/Coordinator. 6. Specialized Rehabilitative Service Therapists, as applicable. 7. To the extent practicable, the participation of the resident and the resident's representative(s). 8. The Charge Nurse responsible for resident care.Every effort will be made to schedule care plan meetings at the best time of the day for the resident and family.

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

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sharon Care Center

8167 West Third St.

Los Angeles, CA 90048

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

assess hydration if intake and symptoms indicate possible significant dehydration.

Level of Harm - Minimal harm or potential for actual harm 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

11/26/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Sharon Care Center

8167 West Third St.

Los Angeles, CA 90048

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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

that they know what steps to take next. During a review of a policy and procedure (P&P) titled, Change in Condition: Notification of, reviewed 12/16/2024 indicated, To ensure residents, family, legal representatives, and physicians are informed of changes in the resident's condition. The same P&P indicated A Facility must immediately inform the resident, consult with the Resident's physician and/or NP, andnotify, consistent with his/her authority, Resident Representative where there is: An accident involving the Resident. A significant change in the Resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental or psychosocial status in either life-threatening conditions or clinical complications). A need to alter treatment significantly (that is, a need to discontinue or change an existing form of treatment due to adverse consequences, or to commence a new form of treatment); or A decision to transfer or discharge

the Resident from the Center. When making notification of above, the Facility must ensure that all pertinent information is available and provided upon request to the physician and/ or NP. During a review of a P&P titled, Physician Orders, reviewed on 12/16/2024 indicated, This will ensure that all physician orders are complete and accurate. The same P&P indicated, Whenever possible, the Licensed Nurse receiving the order will be responsible for documenting and implementing the order. Medication/treatment orders will be transcribed onto the appropriate resident administration record. Orders pertaining to other health care disciplines will be transcribed onto the appropriate communication system for that discipline. During a

review of a P&P titled, Resident Hydration and Prevention of Dehydration, reviewed 3/4/2025, indicated,

This facility will strive to provide adequate hydration and to prevent and treat dehydration. The same P&P indicated under Policy interpretation and implementation the following:- Nurses will assess for signs and symptoms of dehydration during daily care.- Laboratory tests may be ordered to assess hydration if intake and symptoms indicate possible significant dehydration. During a review of the P&P titled, Skin Integrity Management, reviewed 12/16/2024, indicated, To provide safe and effective care to prevent the occurrence of pressure ulcers, manage treatment, and Promote healing of all wounds. The same P&P indicated, Develop comprehensive, interdisciplinary plan of care including prevention and wound treatments, as indicated. Implement pressure ulcer prevention for identified risk factors Determine the need for support surface for bed and chair. Determine the need for offloading devices. Turning and repositioning based on resident care needs For surgical wounds (e.g., flaps, grafts, donors, incisions, etc.), follow specific orders from the surgeon. Implement Special Wound Care treatments/techniques, as indicated and ordered Notify patient, resident representative of plan of care Notify Dietitian and/or rehabilitation services as indicated.

During a review of the P&P titled, CARE PLANNING - INTERDISCIPLINARY TEAM, reviewed on 12/16/2024, indicated, Our facility's Interdisciplinary Team is responsible for the development of an individualized comprehensive care plan for each resident. The same P&P indicated the care plan is based

on the resident's comprehensive assessments developed by the interdisciplinary team with included the following:1. The resident's Attending Physician. 2. A registered nurse with responsibility for the resident. 3.

The Dietary Manager/Dietitian. 4. The Social Services Worker responsible for the resident. 5. The Activity Director/Coordinator. 6. Specialized Rehabilitative Service Therapists, as applicable. 7. To the extent practicable, the participation of the resident and the resident's representative(s). 8. The Charge Nurse responsible for resident care.Every effort will be made to schedule care plan meetings at the best time of

the day for the resident and family.

Event ID:

Facility ID:

If continuation sheet