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Complaint Investigation

Colonial Gardens Nursing Home

Inspection Date: August 15, 2025
Total Violations 1
Facility ID 555715
Location PICO RIVERA, CA
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Inspection Findings

F-Tag F0656

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

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

FORM CMS-2567 (02/99) Previous Versions Obsolete

episodes mood swings from 8/8/2025 to 8/12/2025 and an increase of angry outbursts from 8/9/2025 and 8/10/2025. LVN 4 stated there was no documentation to indicate what incidents occurred and what interventions were implemented to address the episodes of behaviors on 8/8/2025-8/12/2025 (prior to the resident-to-resident alteration on 8/13/2025). LVN 4 stated in addition to the number of episodes of the behavior Resident 2 exhibited, staff should have also documented the location, the behavior Resident 2 was exhibiting, and the endorsement to the following shift in the progress notes. During a concurrent

interview and record review on 8/15/2025 at 2:24 p.m., with Registered Nurse (RN) 1, Resident 2's Care Plan dated 2/11/2024, and progress notes from 8/8/2025 to 8/12/2025 were reviewed. RN 1 stated if a resident exhibited behaviors, licensed nurses should document non-pharmacological (actions to treat a problem without using medication) and pharmacological (using medicine) interventions used and whether those interventions were effective. RN 1 stated this was important to prevent an incident from occurring because of a resident's increased behavior. RN 1 stated Resident 2's progress notes did not indicate what interventions were done during Resident 2's episodes of increased behaviors from 8/8/2025 to 8/12/2025.During a concurrent interview and record review on 8/15/2025 at 4:34 p.m., with the Director of Nursing (DON), Resident 2's care plan dated 2/11/2024 and progress notes dated 8/8/2025 to 8/12/2025 were reviewed. DON stated, staff should monitor and document when a resident exhibited behaviors and notify the physician if there was an increase in those behaviors. The DON also stated if the specific behaviors or incident were not documented, staff would not be able to target and prevent behaviors from recurring. During a review of facility's policy and procedure (P&P) titled, Care Plans, Comprehensive Person-Centered, dated 3/2022, the P&P indicated, A comprehensive, person-centered care plan that includes measurable objectives and timetables to meet the resident's physical, psychosocial, and functional needs is developed and implemented for each resident. The P&P also indicated, When possible, interventions address the underlying source.During a review of facility's P&P titled, Behavioral Assessment, Intervention and Monitoring, dated 3/2019, the P&P indicated, If the resident is being treated for altered behavior or mood, the Interdisciplinary Team (IDT) will seek and document any improvements or worsening

in the individual's behavior, mood, and function.

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📋 Inspection Summary

COLONIAL GARDENS NURSING HOME in PICO RIVERA, CA inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

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 PICO RIVERA, 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 COLONIAL GARDENS NURSING HOME or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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