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Complaint Investigation

The Californian Pasadena Healthcare

September 4, 2025 · Pasadena, CA · 120 Bellefontaine Street
Citations 2
CMS Rating 3/5
Beds 82
Provider ID 055480
Healthcare Facility
The Californian Pasadena Healthcare
Pasadena, CA  ·  View full profile →
Inspection Summary

THE CALIFORNIAN PASADENA HEALTHCARE in PASADENA, CA — inspection on September 4, 2025.

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

FF0655
Resident Assessment and Care Planning Deficiencies
Potential for More Than Minimal Harm

facility's policy and procedure (P&P) titled, Care Plans- Baseline, undated, the P&P indicated a baseline plan of care to meet the resident's immediate health and safety needs was developed for each resident within forty-eight (48) hours or admission.

The baseline care plan included instructions needed to provide effective, person-centered care of the resident that meet professional standards of quality care and must include the minimum healthcare information necessary to properly care for the resident.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

09/04/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

The Californian Pasadena Healthcare

120 Bellefontaine Street Pasadena, CA 91105

SUMMARY STATEMENT OF DEFICIENCIES

During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool), dated 8/19/2025, the MDS indicated Resident 1 had moderately impaired cognitive skills (problems with thinking, memory, judgement) for daily decision making. Resident 1 required substantial/maximal assistance (helper does more than half the effort) with eating and oral/personal hygiene.

The MDS indicated Resident 1 had a central line (PICC) on admission.

During a review of Resident 1's Skin Supplemental Assessment, dated 8/13/2025, the Skin Supplemental Assessment indicated Resident 1 had a right antecubital (the area of the forearm located in front of the elbow) PICC line, 5 French (Fr- unit of measurement for outer diameter of tubing), triple lumen, intact, no signs and symptoms (s/s) of infection noted, total length 41 centimeters (cm- unit of measurement for length).

During a concurrent interview and record review, on 9/4/2025, at 12:14 PM, with the Director of Nursing (DON), Resident 1's medical records were reviewed.

The DON stated it was the responsibility of the Treatment Nurse (TN) or the Registered Nurse (RN) Supervisor to change Resident 1's PICC line dressing at least every seven days.

The DON stated Resident 1's PICC line should have been changed on 8/19/2025 and there was no documentation to indicate Resident 1's PICC line was changed on or before 8/19/2025.

During an interview, on 9/4/2025, at 12:15 PM, with the DON and the Assistant DON (ADON), the ADON stated she changed Resident 1's PICC line but could not state the date it was changed.

The ADON stated she did not document the PICC line dressing change in Resident 1's medical record.

The DON stated if the PICC line change was not documented then it was considered not done.

The DON stated the facility's policy for Central Venous Catheter Care was not followed.

The DON stated it was important to change Resident 1's PICC line dressing to prevent complications like infections.

During a review of the facility's policy and procedure (P&P) titled, Central Venous Catheter Care and Dressing Changes, undated, the P&P indicated to change the dressing if became, damp, loosened or visibly soiled and at least every 7 days.

The P&P indicated that the purpose of this procedure was to prevent complications associated with intravenous (within or through a vein) therapy, including catheter-related infections that were associated with contaminated, loosened, soiled, or wet dressings.

Facility ID:

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 THE CALIFORNIAN PASADENA HEALTHCARE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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