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Complaint Investigation

Golden Rose Care Center

August 7, 2024 · Pasadena, CA · 1899 N Raymond Ave
Citations 2
CMS Rating 1/5
Beds 99
Provider ID 055862
Healthcare Facility
Golden Rose Care Center
Pasadena, CA  ·  View full profile →
Inspection Summary

GOLDEN ROSE CARE CENTER in PASADENA, CA — inspection on August 7, 2024.

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.

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Inspection Findings

FF607
Minimal harm or reading this documentation, she was not made aware about the Resident 1's allegation of abuse on Few 7/28/2024 should have been reported to local agencies, which included California Department of Public affected

During a review of Resident 1's Minimum Data Set (MDS, a standardized assessment and care screening tool), dated 4/26/2024, indicated Resident 1 had no impairment of cognitive skills (mental action or process of acquiring knowledge and understanding through thought and the senses) for daily decision making.

The MDS indicated Resident 1 required setup or clean-up assistance (helper sets up or cleans up; resident completes activity.

Helper assists only prior to or following the activity) with eating.

The MDS indicated Resident 1 required partial/moderate assistance (helper does less than half the effort.

Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort) with oral hygiene, toileting hygiene, shower, upper and lower body dressing, putting on/taking off footwear and personal hygiene.

During a review of Resident 1's progress note dated 7/28/2024, time indicated 1:20 PM, it indicated Resident 1 has an allegation of abuse.

During an interview on 8/7/2024 at 3:50 PM, with Licensed Vocational Nurse 1 (LVN 1), LVN 1 stated, the alleged abuse should be reported to local agencies, which included California Department of Public Health, ombudsman, and local enforcement agency within two (2) hours form when the allegation was made.

During a concurrent record review of Resident 1's progress notes dated 7/28/2024, timed 1:20 PM, and interview with LVN 1 on 8/7/2024 at 3:55 PM, LVN 1 stated, he documented the progress notes on 7/28/2024 at 1:20 PM, and he indicated in progress notes that Resident 1 stated of being abused by a Certified Nurse Assistant (CNA). LVN 1 stated he did not think of reporting it as an abuse because Resident 1 was just not happy with the CNA.

055862

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 055862 B.

Wing 08/07/2024

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

Golden Rose Care Center 1899 N Raymond Ave Pasadena, CA 91103

During a review of Resident 1's Minimum Data Set (MDS, a standardized assessment and care screening tool), dated 4/26/2024, indicated Resident 1 had no impairment of cognitive skills (mental action or process of acquiring knowledge and understanding through thought and the senses) for daily decision making.

The MDS indicated Resident 1 required setup or clean-up assistance (helper sets up or cleans up; resident completes activity.

Helper assists only prior to or following the activity) with eating.

The MDS indicated Resident 1 required partial/moderate assistance (helper does less than half the effort.

Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort) with oral hygiene, toileting hygiene, shower, upper and lower body dressing, putting on/taking off footwear 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

055862

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 055862 B.

Wing 08/07/2024

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

Golden Rose Care Center 1899 N Raymond Ave Pasadena, CA 91103

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 PASADENA, 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 GOLDEN ROSE CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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