Torrance Care Center West, Inc

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

Resident 1's concern in a timely manner by filing grievance for her as soon as she found out about the complaint. The SSD stated, she should not have assumed that Resident 1 knew how to file the grievance.

The SSD stated it was the resident's right to file the grievance.During an interview on 9/15/2025, at 2:50 p.m., with the Director of Nursing (DON), the DON stated, the SSD should have provided the information regarding how to file grievance and the process of grievance to Resident 1 and family members since there was an ongoing complaint regarding brief change. The DON stated that the residents should know how to file grievance to exercise their rights. During a review of the facility's Policy and Procedure(P&P) titled, Grievance/Concerns, undated, the P&P indicated, The staff shall respond promptly and appropriately to concerns or complaints expressed by residents or their family, friends, or responsible party. Filing of Grievance: Grievances must be submitted to the coordinator or designee within 30 days of becoming aware of the alleged discrimination action. The coordinator or designee shall conduct an investigation of the complaint to determine its validity. The investigation may be informal, but it must be thorough, affording all interested parties/persons an opportunity to submit evidence relevant to the complaint. The coordinator or designee will issue a written decision on the grievance no later than 30 days after its filing.During a review of the facility's Policy and Procedure(P&P) titled, Social Service Director: Job Description, undated, the P&P indicated, Major Duties and Responsibilities: The Social Service Director will assist residents in voicing and obtaining resolution to grievances. The Director will review complaints and grievances made by the resident and make a written report indicating what action(s) were taken to resolve the complaint or grievance.

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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

09/15/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Torrance Care Center West, Inc

4333 Torrance Blvd Torrance, CA 90503

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

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

the Minimum Data Set Coordinator (MDSC), Resident 1's Care Plan (CP), revised 8/14/2025, the CP Focus indicated, Resident 1 had aggressive behavior during diaper change. The CP goal indicated, Resident 1 will have no evidence of behavior problems by review date (10/9/2025). The CP Interventions indicated to explain why behavior was inappropriate, approach in a calm manner, and attempt to determine underlying cause. The MDSC stated, Resident 1's care plan goal was not objective and measurable. The MDSC stated that interventions were generic (not specific). The MDSC stated Resident 1's care plan did not address the actual issue of accommodating Resident 1's requests to adjust her adult brief in a comfortable way.During

an interview on 9/15/2025, at 2:50 p.m., with the DON, the DON stated, care plans are created to guide the staff on how to care for residents with identified problems. The DON stated, without a care plan with specific interventions, a resident may have a recurrence of an issue or a worsening of a condition. The DON stated, IDT meeting should have developed individualized resident centered care plans and interventions. The DON stated, these interventions should have been implemented and reevaluated for effectiveness. The DON stated that Resident 1's care plan was not specific and individualized due to lack of recommendation from the IDT meeting. The DON stated that Resident 1's adult brief adjustment issue would not be resolved unless specific and resident centered interventions were implemented. The DON stated it might lead to a delay in delivery of care and services.During a review of the facility's Policy and Procedure(P&P) titled, Care Planning-Interdisciplinary Team, undated, the P&P indicated, Policy Statement: Our facility's Care Planning/Interdisciplinary Team is responsible for the development of an individualized comprehensive care plan for each resident.During a review of the facility's Policy and Procedure(P&P) titled, Comprehensive Care Plan, undated, the P&P indicated, Policy: It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment. Policy Explanation and Compliance Guidelines: 1. Person-centered care means focusing on the resident as the locus of control and supporting

the resident in making their own choices and having control over their daily lives. 2. The care planning process will include an assessment of the resident's strengths and needs and will incorporate the resident's personal and cultural preferences in developing goals of care. 7. The comprehensive care plan will include measurable objectives and timeframes to meet the resident's needs as identified in the resident's comprehensive assessment. The objectives will be utilized to monitor the resident's progress. Alternative interventions will be documented, as needed.

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