Meadow Creek Post-acute
MEADOW CREEK POST-ACUTE in PARAMOUNT, CA — inspection on February 24, 2026.
Found 2 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
actions that can be measured.
interview and record review, the facility failed to ensure a Care Plan was created for one of four
the potential for Resident 1 to have further skin breakdown, increased risk of infection, pain, and diminished quality of life.Findings:During a review of Resident 1's admission Record (Face Sheet), the Face Sheet indicated Resident 1 was admitted to the facility on [DATE], with diagnoses including nontraumatic intracerebral (inside the brain tissue) hemorrhage (sudden bleed), acute respiratory failure (serious condition where a person cannot breathe on their own), quadriplegia (paralysis from the neck down, including legs and arms usually due to spinal cord injury) and type 2 diabetes ([DM] a disorder characterized by difficulty in blood sugar control and poor wound healing).During a review of Resident 2's Minimum Data Set ([MDS] a resident assessment tool), dated 11/24/2025, the MDS indicated Resident 1 had severe cognitive (ability to think and reason) impairment and was rarely or never understood by others.
The MDS indicated Resident 1 was dependent on staff for oral hygiene, toileting hygiene, showering and dressing.
The MDS indicated Resident 1 was at risk for developing pressure injuries (localized damage to the skin and/or underlying tissue usually over a bony prominence).During a review of Resident 1's Change of Condition (COC), dated 1/17/2026, the COC indicated Resident 1 was noted with erythema (redness) and moisture association maceration (the softening, whitening, and breaking down of skin caused by prolonged exposure to moisture, such as sweat, urine, or wound drainage) to his scrotal area and penis.
During an interview on 2/24/2026, at 11:57 a.m., Licensed Vocational Nurse (LVN) 1, stated she assessed Resident 1's skin on 1/17/2026 and created the COC, but failed to create a Care Plan to reflect Resident 1's COC. LVN 1 stated failure to develop a Care Plan to address Resident 1's skin changes could cause a delay in Resident 1 receiving timely assessments and consistent treatments.
During an interview on 2/24/2026, at 4 p.m., the Director of Nursing (DON) stated Resident 1 is at risk for skin breakdown and all COCs must be identified and followed up with an appropriate Care Plan to address the goals and interventions.
The DON stated a Care Plan is a tool used to communicate a resident's plan of care to the staff to ensure consistent care with all bedside care givers.
The DON stated a lack of a comprehensive centered care plan, placed Resident 1 at further risk for skin breakdown due to potential lack of care and services.During a review of the facility's policy and procedure (P&P) titled, Care Plans, Comprehensive Person-Centered, revised 4/2017, the P&P indicated the Interdisciplinary Team ([IDT] a team of health care workers from different specialties working together to meet the residents' care needs/goals) reviews and updates the care plan when there has been a significant change in the resident's condition.
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
056166 02/24/2026
Meadow Creek Post-Acute 7039 Alondra Blvd Paramount, CA 90723
During a review of Resident 1's Order Recap Report (physician's orders), dated 1/1/2026 to 2/28/2026, indicated Resident 1 was to receive Hydrocortisone External Ointment 2.5% topically to bilateral groin MASD every shift, ordered on 2/13/2026.During a review of Resident 1's Medication Administration Record ([MAR] a daily documentation record used by a licensed nurse to document medications and treatments given to a resident) dated 2/2026, the MAR indicated Resident 1 received Hydrocortisone External Ointment 2.5 % every shift on the following days: 2/13/2026 during the night shift, 2/14/2026 during the day shift, 2/14/2026 during the night shift, 2/15/2026 during the day shift, and 2/15/2026 during the night shift.
During a review of email communication between Registered Nurse (RN) 1 and the Director of Nursing (DON), dated 2/17/2026, the email indicated RN 1 failed to check Resident 1's allergies when the physician ordered hydrocortisone cream.During a telephone interview on 2/24/2026 at 2:48 p.m., Licensed Vocational Nurse (LVN) 3 stated she administered hydrocortisone to Resident 1 as ordered but did not check his allergies prior to giving the medication. LVN 3 stated failing to check Resident 1's allergies place him at risk for allergic reactions, including itching, swelling, and difficulty breathing.
During an interview on 2/24/2026 at 4 p.m. the DON stated based on her investigation and review of Resident 1's documentation, three nurses administered hydrocortisone ointment without checking his documented allergies.
The DON stated failing to verify his allergies prior to administering hydrocortisone placed Resident 1 at risk for skin irritation, further skin breakdown, increased discomfort, and potentially severe reactions, including anaphylaxis which could lead to difficulty breathing.
During a review of the facility's policy and procedure (P&P) titled, Administering Medications, revised 4/2019, the P&P indicated the resident's allergies are checked/verified prior to administering medications.
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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.