Skip to main content
Complaint Investigation

Ararat Nursing Facility

June 14, 2024 · Mission Hills, CA · 15099 Mission Hills Road
Citations 4
CMS Rating 1/5
Beds 254
Provider ID 555579
Healthcare Facility
Ararat Nursing Facility
Mission Hills, 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

Ararat Nursing Facility in MISSION HILLS, CA — inspection on June 14, 2024.

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

FF0600
Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical

jeopardy to resident health or last revised date of 2/29/2024, indicated, It is the policy of this facility to provide the highest quality safety of care in the safest environment for the residents residing in the facility.

Program, with last revised dated 8/1/2023, indicated, 1.

Each resident has the right to be free from abuse, neglect, mistreatment, and/or misappropriation of property (illegal use of another person's property of funds).

The Facility has zero-tolerance for abuse, neglect, mistreatment, and/or misappropriation of resident property.

Staff must not permit anyone to engage in verbal, mental, sexual, or physical abuse, neglect, mistreatment, or misappropriation of property. 2.

The facility is committed to protecting residents from abuse by anyone, including but not limited to Facility Staff The policy also defines neglect as Leaving someone unattended who needs supervision.

555579 06/14/2024

Ararat Nursing Facility 15099 Mission Hills Road Mission Hills, CA 91345

to use the lift machine. CNA 1 stated one staff needed to stand next to the lift machine and the other

jeopardy to resident health or alone and should not have left the machine with the resident. safety On 6/14/2024 at 12:04 p.m., during a concurrent interview and record review of Resident 1's physician

not have a Physician's Order for use of a mechanical lift device RN 4 stated, I would not have left the resident (Resident 1) alone RN 4 stated I would not leave the lift machine unattended because we always make sure the residents' environment needs to be free from hazards. RN 4 stated this lifting machine for this case was a hazard because it is made of metal. RN 4 stated, because CNA 1 left Resident 1 alone, and because the mechanical lift was left unattended at Resident 1's bedside, Resident 1 ended up having a fall with a sustained injury. A concurrent record review of Resident 1's Progress notes, dated 6/1/2024 at 12:10 p.m., indicated that Resident 1 had a skin tear on the forehead, and was bleeding from the left eye and nose.

On 6/14/2024 at 1:05 p.m., during an interview, LVN 5 stated CNA 1 left Resident 1 alone with the lift machine (mechanical lift) in the room, and CNA 1 was supposed to keep Resident 1 safe. LVN 3 stated, The machine should not be there, and it should have been the floormat as per care plan. LVN 3 stated CNA 1 could lower the bed, replace the floormat, and remove the machine. LVN 3 stated, Because this was not done, the resident fell off the bed. LVN 3 stated Resident 1 sustained a skin tear on the forehead, and bleeding from the left eye and nose.

A review of the current facility-provided policy and procedure titled, Total Mechanical Lift, revised on 8/1/2014, indicated, The resident will have a physician's order for the use of a mechanical lift.

A review of the current facility-provided policy and procedure titled, Resident Rooms and Environment, with last revised date of 11/1/2017, indicated, Facility Staff will provide residents with a pleasant environment and person-centered care that emphasizes the residents' comfort, independence, and personal needs and preferences.

This shall include ensuring that residents can receive care and services safely and that the physical layout of the Facility maximizes resident independence and does not pose a safety risk.

A review of the current facility-provided policy and procedure titled, Care Planning, with last revised date of 10/24/2022, indicated, To ensure that a comprehensive person-centered Care Plan is developed for each resident based on their individual assessed needs.

The policy indicated, The resident has the right to receive the services and/or items included in the plan of care.

A review of the current facility-provided policy and procedure titled, Safety of Residents, with last revised date of 5/1/2023, indicated the purpose, To provide a safe environment for residents and Facility staff.

A review of the current facility-provided policy and procedure titled, Fall Management Program, with last revised date of 2/29/2024, indicated, It is the policy of this facility to provide the highest quality of care in the safest environment for the residents residing in the facility.

F-F600.

Findings:

A review of Resident 1's Admission Record indicated the facility admitted Resident 1 on 7/9/2021 with diagnoses including parkinsonism, Alzheimer's disease (a brain disorder affecting memory and thinking skills that worsens over time), dementia (loss of thinking or remembering affecting daily life), and age-related osteoporosis (loss of bone mass with increasing risk for bone breakage).

A review of Resident 1's Minimum Data Set (MDS - a standardized assessment and care screening tool), dated 5/14/2024, indicated that Resident 1's cognitive skills (ability to think and process information) for daily decision-making tasks were severely impaired.

The MDS indicated Resident 1 was dependent (helper does ALL the effort and resident does none of the effort to complete the activity or the assistance of two or more helpers is required for the resident to complete the activity) for eating, oral hygiene (cleaning teeth), toileting hygiene, shower or bathing, upper and lower body dressing, putting on or removing footwear, and personal hygiene needs (combing hair and washing or drying face or hands).

A review of Resident 1's record titled, Progress Notes, dated 6/1/2024 at 12:10 p.m., indicated that Resident 1's assigned CNA (CNA 1) was about to weigh Resident 1 with a lift machine (mechanical lift, a lift device with a weighing scale designed to lift and transfer patients from a bed to a wheelchair or vice versa). CNA 1 then left Resident 1 unattended to ask for assistance from another staff member (unidentified). CNA 1 was then quoted as stating, I was almost at the door when I heard a loud sound. I turned my back, opened the curtain and I saw my resident (Resident 1) on the floor on the legs of the lifting machine.

The record indicated CNA 1 noted blood around Resident 1's head.

555579

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 555579 B.

Wing 06/14/2024

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

Ararat Nursing Facility 15099 Mission Hills Road Mission Hills, CA 91345

F-F689.

Findings:

A review of Resident 1's Admission Record indicated the facility admitted Resident 1 on 7/9/2021 with diagnoses including parkinsonism, Alzheimer's disease (a brain disorder affecting memory and thinking skills that worsens over time), dementia (loss of thinking or remembering affecting daily life), and age-related osteoporosis (loss of bone mass with increasing risk for bone breakage).

A review of Resident 1's Minimum Data Set (MDS - a standardized assessment and care screening tool), dated 5/14/2024, indicated that Resident 1's cognitive skills (ability to think and process information) for daily decision-making tasks were severely impaired.

The MDS indicated Resident 1 was dependent (helper does ALL the effort and resident does none of the effort to complete the activity or the assistance of two or more helpers is required for the resident to complete the activity) for eating, oral hygiene (cleaning teeth), toileting hygiene, shower or bathing, upper and lower body dressing, putting on or removing footwear, and personal hygiene needs (combing hair and washing or drying face or hands).

555579

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 555579 B.

Wing 06/14/2024

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

Ararat Nursing Facility 15099 Mission Hills Road Mission Hills, CA 91345

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 MISSION HILLS, 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 Ararat Nursing Facility 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.