Seacrest Post-acute Care Center

F 0573 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

the confidentiality of each resident's personal and protected health information. The P&P indicated all information contained in the resident's medical record is confidential and may only be released by the written consent of the resident or legal representative, consistent with state laws and regulations, a discharged resident may obtain photocopies of his records by providing the facility with at least 15 calendar days advance notice of such request. The facility will transmit copies within 15 calendar days after receiving

the written request.

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Printed: 04/13/2026 Form Approved OMB No. 0938-0391

Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION

(X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER:

(X2) MULTIPLE CONSTRUCTION

B. Wing

A. Building

(X3) DATE SURVEY COMPLETED

08/31/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Seacrest Post-Acute Care Center

1416 West 6th Street San Pedro, CA 90732

For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG

SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0678 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few

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

1 was not breathing) and did not have any detectable pulse. RN 1 stated she was CPR certified but she did not attempt CPR and instructed LVN 1 not to perform CPR nor call 911 because she thought Resident 1's POLST indicated Do Not Resuscitate ([DNR] if a person's heart or breathing stops, the person wishes the doctors and nurses not to restart it by doing CPR). During an interview on [DATE REDACTED] at 2:46 p.m., the DON stated when a resident is found unresponsive, staff should immediately check for a pulse, if the resident does not have a pulse, then immediately start chest compressions, call for help, and immediately call 911.

The DON stated, if chest compressions and/or CPR was not initiated immediately after the heart stops beating, the chances of the resident's survival decreases and the risk of permanent brain damage or death increases. The DON stated the resident's POLST must be honored.During a telephone interview on [DATE REDACTED] at 5:46 p.m., the Facility Medical Director (MD 3) stated the facility must honor the residents' wishes as indicated in their POLST. During a review of the facility's Policy & Procedure (P&P) titled, Emergency Procedure-Cardiopulmonary Resuscitation, dated 2001, the P&P indicated if a resident is found unresponsive, briefly assess for abnormal or absence of breathing. If sudden cardiac arrest is likely, begin CPR: instruct a staff member to activate the emergency response system (code) and call 911, instruct a staff member to retrieve the automatic external defibrillator (an external defibrillator is a machine that helps restart a person's heart if it suddenly stops or beats the wrong way), verify or instruct a staff member to verify DNR or code status of the individual, initiate the basic life support (BLS- compressions, airway, breathing) sequence of events. During a review of an online article titled, American Heart Association 2020, CPR and Emergency Cardiovascular (anything that has to do with the heart and blood vessels) Care Committee Guidelines, the article indicated, the adult basic life support algorithm (a process or set rules to be followed) for healthcare providers included verifying for scene safety, check for responsiveness, shout for nearby help, look for no breathing or only gasping and check pulse simultaneously (at the same time). The guidelines further indicated if there was no breathing, or only gasping, with no pulse, to immediately begin CPR and perform cycles of thirty chest compressions and two breaths.AHH CPR Guidelines During a

review of an online article titled, How to Perform CPR - Adult CPR Steps the article indicated, to check the scene for safety, check the person for responsiveness/breathing, if the person does not respond and is not breathing or only gasping, call 911, get equipment, or tell someone to do so, kneel beside the person, and place them on their back on a firm, flat surface. The guidelines indicated to begin chest compressions 30 at

a time, give two breaths and to continue the cycle of 30 chest compression and two breaths.www.redcross.org During a review of the facility's P&P titled, POLST/ Advanced directive, undated 2001, the P&P indicated the purpose of the P&P was to specify the form to be used by the facility in documenting resident's preferred intensity of care. The P&P indicated the facility will honor a resident's completed POLST form from the hospital if there is no change to it. The facility must review the POLST with

the resident / responsible party and document that this is in the resident's medical records.During a review of the POLST (in general) form, the form indicated the following: 1. First follow these orders, then contact

the Physician/Nurse Practitioner/Physician Assistant.2. A copy of the signed POLST form is a legally valid physician's order. Any section not completed implies full treatment for that section.

Event ID:

Facility ID:

If continuation sheet