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Complaint Investigation

Seacrest Post-acute Care Center

September 10, 2025 · San Pedro, CA · 1416 West 6th Street
Citations 5
CMS Rating 1/5
Beds 80
Provider ID 055070
Healthcare Facility
Seacrest Post-acute Care Center
San Pedro, CA  ·  View full profile →
Inspection Summary

SEACREST POST-ACUTE CARE CENTER in SAN PEDRO, CA — inspection on September 10, 2025.

Found 5 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

FF0580
Resident Rights Deficiencies
Potential for More Than Minimal Harm

During a concurrent interview and record review on 9/10/2025 at 1:47 p.m. with the ADON, the facility's policy and procedure (P&P), titled Change in a Resident's Condition or Status, revised February 2021, was reviewed.

The P&P indicated the nurse will notify the resident's attending physician or physician on call when there has been a(an) accident or incident involving the resident.

The ADON stated the resident being found outside the facility is considered an incident that should have been communicated to the physician.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

09/10/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Seacrest Post-Acute Care Center

1416 West 6th Street San Pedro, CA 90732

SUMMARY STATEMENT OF DEFICIENCIES

During a review of facility hallway video footage with starting timestamp of 8/25/2025 7:23:45 p.m., the footage indicated:Received footage of [NAME]/[NAME] altercation from medical records. 8/25/2025 7:24:15 PM: Resident 1 makes left hand into a fist as Resident 2 and Staff Walk down the hallway toward Resident 1. 8/25/2025 7:24:20 PM: Resident 1 extends left fist and makes contact with the back of Resident 2 as Staff member and Resident 2 walk by. 8/25/2025 7:24:24 PM: Resident 2 uses right fist to punch left side of Resident 1's face making contact with Resident 1's glasses.

During a review of the facilities P&P, titled Care Plans, Comprehensive Person-Centered, revised March 2022 the P&P indicated care plans are revised as information about the residents and the resident's conditions change.

The P&P indicated the interdisciplinary team reviews and updates the care plan when there has been a significant change in the resident's condition.

During a review of the facility's P&P, titled Safety and Supervision of Residents, revised July 2017 the P&P indicated the interdisciplinary care team shall analyze information obtained from assessments and observations to identify any specific accident hazards or risks for individual residents.

The P&P indicated the facility-oriented and resident-oriented approaches to safety are used together to implement a systems approach to safety, which considers the hazards identified in the environment and individual resident risk factors, and then adjusts interventions accordingly.

The P&P indicated risk factors and environmental hazards include unsafe wandering.

During a review of the facility's policy and procedure (P&P), titled Abuse, Neglect, Exploitation and Misappropriation Prevention Program, revised April 2021, the P&P indicated residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation.

The P&P indicated the resident abuse, neglect and exploitation prevention program consists of a facility-wide commitment and resource allocation to support the following objectives: protect residents from abuse, neglect, exploitation or misappropriation of property by anyone including other residents.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

09/10/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Seacrest Post-Acute Care Center

1416 West 6th Street San Pedro, CA 90732

SUMMARY STATEMENT OF DEFICIENCIES

During a review of the facility's policy and procedure (P&P), Verification of Informed Consent for Psychotherapeutic Medications, revised May 2024, the P&P indicated the facility will obtain a written informed consent for treatment using psychotherapeutic drugs and consent renewal every six months.

During a review of the facility's P&P, titled Psychotropic Medication Use, revised July 2022. the P&P indicated psychotropic medication management includes indications for use, adequate monitoring for efficacy and adverse consequences, and preventing, identifying, and responding to adverse consequences.

The P&P indicated consideration of the use of any psychotropic medication is based on comprehensive review of the resident which includes evaluation or the resident's signs and symptoms in order to identify underlying causes.

The P&P indicated residents receiving psychotropic medications are monitored for adverse consequences.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

09/10/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Seacrest Post-Acute Care Center

1416 West 6th Street San Pedro, CA 90732

SUMMARY STATEMENT OF DEFICIENCIES

review of the facility's policy and procedure (P&P), titled Safety and Supervision of Residents, revised July 2017, the P&P indicated the interdisciplinary care team shall analyze information obtained from assessments and observations to identify any specific accident hazards or risks for individual residents.

The P&P indicated the facility-oriented and resident-oriented approaches to safety are used together to implement a systems approach to safety, which considers the hazards identified in the environment and individual resident risk factors, and then adjusts interventions accordingly.

The P&P indicated risk factors and environmental hazards include unsafe wandering.

Facility ID:

IDENTIFICATION NUMBER:

A.

Building

COMPLETED

09/10/2025

STREET ADDRESS, CITY, STATE, ZIP CODE

Seacrest Post-Acute Care Center

1416 West 6th Street San Pedro, CA 90732

SUMMARY STATEMENT OF DEFICIENCIES

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During a concurrent interview and record review on 9/10/2025 at 4:02 p.m., LVN 1's employee file was reviewed.

The DSD stated LVN 1's date of hire was 5/14/2025.

The DSD stated LVN 1 has one competency checklist dated 9/2/2025.

The DSD stated there are no other competency skill checklists in LVN 1's employee file.

The DSD stated the medication competency checklist is completed by the Director of Nursing (DON) and completed upon hire and yearly after.During a review of the facility's P&P titled Administering Medications, revised April 2019, was reviewed.

The P&P indicated medications are administered in accordance with prescriber orders.

The P&P indicated medication administration times are determined by resident need and benefit, not staff convenience.

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 SAN PEDRO, 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 SEACREST POST-ACUTE CARE CENTER or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.


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