Sharon Care Center
SHARON CARE CENTER in LOS ANGELES, CA — inspection on November 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
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.
Facility ID:
IDENTIFICATION NUMBER:
A.
Building
COMPLETED
11/26/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
Sharon Care Center
8167 West Third St.
Los Angeles, CA 90048
SUMMARY STATEMENT OF DEFICIENCIES
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.
Facility ID:
IDENTIFICATION NUMBER:
A.
Building
COMPLETED
11/26/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
Sharon Care Center
8167 West Third St.
Los Angeles, CA 90048
SUMMARY STATEMENT OF DEFICIENCIES
assess hydration if intake and symptoms indicate possible significant dehydration.
Facility ID:
IDENTIFICATION NUMBER:
A.
Building
COMPLETED
11/26/2025
STREET ADDRESS, CITY, STATE, ZIP CODE
Sharon Care Center
8167 West Third St.
Los Angeles, CA 90048
SUMMARY STATEMENT OF DEFICIENCIES
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.
Facility ID: