Sunray Healthcare Center

F-F550.

Findings:

A review of Resident 1 ' s Admission Record dated 7/9/24, indicated Resident 1 was admitted to the facility

on [DATE REDACTED], with diagnoses including, monoplegia (paralysis) of the left non dominate side, muscle weakness, anxiety, diabetes mellitus type two (a condition were your body has trouble controlling the level of sugar in

the blood), chronic obstructive pulmonary disease (COPD, a group of lung diseases that block airflow and make it difficult to breath), and urinary tract infection.

A review of Resident 1 ' s History and Physical (H&P), dated 3/1/24, indicated, Resident 1 has the capacity to understand and make decisions.

A review of Resident 1 ' s Minimum Data Set (MDS, a standardized assessment and care screening tool), dated 6/12/24 indicated Resident 1 required supervision from staff for eating, and maximal assistance to total dependence on staff for bed mobility, toileting, dressing, and personal hygiene.

During an interview with Resident 1 on 7/8/24 at 1:25 pm, Resident 1 stated some of staff are incompetent or do not want to do their job. States he has been left wet (from urinary incontinence) for hours and the night shift will not change him before 4:30 am, and he had situation more than once where the urine had soaked his whole back all the way up to his pillow. Stated he should be changed at minimum twice a shift, even had

a sign put up above his bed indicating that.

During an interview with Certified Nurse Assistant (CNA) 2, on 7/9/24 at 1:44 pm, CNA 2 stated there would be times she would come on her shift at 7 am and find the residents from night shift would be soiled. CNA 2 corroborated Resident 1 ' s statement being left wet with urine to the point where the sheets soaked through and dripping because night shift staff failed to assist the resident.

During and interview with Director of Nursing (DON), on 7/9/24 at 2:55 pm, DON stated best practices for incontinence would be to change the resident a least two times a shift, it is unacceptable to leave a resident for hours without changing the resident.

A review of the facility ' s policy and procedures (P&P) titled Prevention of Pressure Injuries, revision date of April 2020, the P&P indicated, Skin Care . 1. Keep the skin clean and hydrated. 2. Clean promptly after episodes of incontinence.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 3 of 3 055870

F-F677.

Findings:

A review of Resident 1 ' s Admission Record dated 7/9/24, indicated Resident 1 was admitted to the facility

on [DATE REDACTED], with diagnoses including, monoplegia (paralysis) of the left non dominate side, muscle weakness, anxiety, diabetes mellitus type two (a condition were your body has trouble controlling the level of sugar in

the blood), chronic obstructive pulmonary disease (COPD, a group of lung diseases that block airflow and make it difficult to breath), and urinary tract infection.

A review of Resident 1 ' s History and Physical (H&P), dated 3/1/24, indicated, Resident 1 has the capacity to understand and make decisions.

A review of Resident 1 ' s Minimum Data Set (MDS, a standardized assessment and care screening tool), dated 6/12/24 indicated Resident 1 required supervision from staff for eating, and maximal assistance to total dependence on staff for bed mobility, toileting, dressing, and personal hygiene.

A review of Resident 5 ' s Admission Record dated 7/9/24, indicated Resident 5 was admitted to the facility

on [DATE REDACTED], with diagnoses including, COPD, cardiomyopathy (chronic disease of the heart muscle), hemiplegia (paralysis on one side) and hemiparesis (weakness on one side) following cerebral infarction (stroke) affecting the left non-dominant side.

A review of Resident 5 ' s H&P, dated 3/1/24, indicated, Resident 5 has the capacity to understand and make decisions.

A review of Resident 5 ' s MDS, dated [DATE REDACTED] indicated Resident 5 totally dependent on staff for eating, bed mobility, toileting, dressing, and personal hygiene.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date

these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 1 of 3 055870 Department of Health & Human Services Printed: 09/18/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 055870 B. Wing 07/09/2024

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

Sunray Healthcare Center 3210 W Pico Blvd Los Angeles, CA 90019

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 0550 During an interview on 7/8/24 at 1:25 pm with Resident 1, the resident stated has been treated and talked to rudely by staff at night, stating they are ghetto, not friendly, and will yell. Resident 1 further stated staff will Level of Harm - Minimal harm or not tell me their names. potential for actual harm

During an interview on 7/8/24 at 1:30 pm, Certified Nursing Assistant (CNA) 1, stated they make the good Residents Affected - Few nurses leave then they hire bad ones, I ' ve heard that night shift (11 pm to 7 am) yells, gets into fights and are unprofessional. They have no compassion, only come to work for the money.

During an interview on 7/9/24 at 9:20 am, Resident 5 stated there was a staff at night that yells at residents and the staff are very loud, which is very disrespectful. Resident 5 further stated the staff have a bad attitude when answering the call light.

A review of the facility ' s policy and procedures (P&P) titled, Resident rights, revised on 2/2021, indicated Employees shall treat all residents with kindness, respect and dignity . Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident ' s rights to be treated with respect, kindness, and dignity.

FORM CMS-2567 (02/99) Event ID: Facility ID: If continuation sheet Previous Versions Obsolete Page 2 of 3 055870 Department of Health & Human Services Printed: 09/18/2025 Form Approved OMB Centers for Medicare & Medicaid Services No. 0938-0391

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A. Building 055870 B. Wing 07/09/2024

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

Sunray Healthcare Center 3210 W Pico Blvd Los Angeles, CA 90019

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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable.

Level of Harm - Minimal harm or **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 44252 potential for actual harm Based on interview, and record review, the facility failed to ensure incontinence care was provided a timely Residents Affected - Few manner for one of five sampled residents (Resident 1).

This deficeint practice had the potential to result in infection, illness and effect the resident ' s self-esteem and quality of life.

Cross Reference: