North Valley Nursing Center

During a review of the Minimum Data Set (MDS - a resident assessment tool), dated 2/23/2026, the MDS indicated Resident 22's cognition (the mental processes involved in acquiring, processing, storing, and retrieving information) was intact.

During a review of Resident 22's History and Physical (H&P), dated 10/10/2025, the H&P indicated Resident 22 had capacity to understand and make own decisions.

During an interview on 5/18/2026 at 11:55 a.m. with Resident 22, Resident 22 stated the facility had not provided quarterly financial statements for several months.

During a review of Resident 54's admission Record, the admission Record indicated the facility originally admitted Resident 54 to the facility on [DATE] and readmitted on [DATE] with diagnoses including sequelae following unspecified cerebrovascular disease (a condition with unknown cause that affects blood vessels and blood supply to the brain often leading to brain damage), obstructive hydrocephalus (a blockage in the brain that prevents the normal flow of cerebrospinal fluid through brain passages), and presence of cerebrospinal fluid drainage device (a surgically implanted device to remove excess fluid from the brain).

During a review of the MDS, dated [DATE], the MDS indicated Resident 54's cognition was moderately impaired.

During a review of Review of Resident 54's H&P dated 4/6/2026, the H&P indicated Resident 54 did not have the capacity to understand and make decisions.

During a concurrent interview and record review on 5/22/2026 at 1:03 p.m. with the Business Office Manager (BOM), the facility's policy and procedure (P&P) titled, Resident Trust Funds, last reviewed 1/14/2026, was reviewed.

The P&P indicated the facility: -Provide a quarterly statement each quarter to each resident or resident representative (RP) reflecting all transactions and balances. -Date and document when the statement is provided. -Requests the signature of the resident or RP as proof of receipt of quarterly statement. -All reports printed and placed in a Patient Trust Binder.

The BOM stated the facility did not follow the P&P by not providing Resident 54 and Resident 22 quarterly statements for the quarter period of 1/1/2026 to 3/31/2026.

During an interview on 5/22/2026 at 1:51 p.m. with the Administrator, the Administrator stated quarterly statements should be provided to each resident or RP and the BOM office maintains records of quarterly statements given to residents or RP.

During an interview on 5/22/2026 at 3:08 p.m. with Resident 54's RP, the RP stated the facility had not provided quarterly statements of Resident 54's account for about one year and is not aware of Resident 54's account balance.

055146 05/22/2026

North Valley Nursing Center 7660 Wyngate St Tujunga, CA 91042

During a review of the Minimum Data Set (MDS - a resident assessment tool), dated 2/23/2026, the MDS indicated Resident 22's cognition (the mental processes involved in acquiring, processing, storing, and retrieving information) was intact.During a review of Resident 22's History and Physical (H&P), dated 10/10/2025, the H&P indicated Resident 22 had capacity to understand and make own decisions.

During an interview on 5/18/2026 at 11:55 a.m. with Resident 22, Resident 22 stated the facility had not provided quarterly financial statements for several months.

During a review Resident 22's Resident Fund Statement, dated 1/1/2026 to 3/31/2026, the Resident Fund Statement indicated an account balance of $4,851.02.

During a review of Resident 54's admission Record, the admission Record indicated the facility originally admitted Resident 54 to the facility on [DATE] and readmitted on [DATE] with diagnoses including sequelae following unspecified cerebrovascular disease (a condition with unknown cause that affects blood vessels and blood supply to the brain often leading to brain damage), obstructive hydrocephalus (a blockage in the brain that prevents the normal flow of cerebrospinal fluid through brain passages), and presence of cerebrospinal fluid drainage device (a surgically implanted device to remove excess fluid from the brain).

During a review of the MDS, dated [DATE], the MDS indicated Resident 54's cognition was moderately impaired.

During a review of Review of Resident 54's H&P dated 4/6/2026, the H&P indicated Resident 54 did not have the capacity to understand and make decisions.

During a review Resident 54's Resident Fund Statement, dated 1/1/2026 to 3/31/2026, the Resident Fund Statement indicated an account balance of $4,423.84.

During a concurrent interview and record review on 5/22/2026 at 1:03 p.m. with the Business Office Manager (BOM), the facility's policy and procedure (P&P) titled, Resident Trust Funds, last reviewed on 1/14/2026,ˆwas reviewed.

The P&Pˆindicatedˆthe facility will provide written notification to recipients of Medicaid or their Resident Representative (RP) when their Resident Fund Trust balance approach $200 of the resource limits.

The BOM stated the facility didˆnot follow the P&P to provide notification to Resident 22 and Resident 54 when their resource limits were approaching $2000; and Resident 22 and Resident 54 could be at risk of losing Medicaid benefits.ˆ

055146 05/22/2026

North Valley Nursing Center 7660 Wyngate St Tujunga, CA 91042

During a review of Resident 7's Minimum Data Set (MDS - a resident assessment tool) dated 4/19/2025, the MDS indicated Resident 7 sometimes understood others and sometimes understands others.

The MDS indicated Resident 7 was dependent (helper does all of the effort) with activities of living (ADL - routine activities such as bathing, dressing, and toileting a person performs daily).

The MDS indicated Resident 7's was dependent for all mobility.

During a review of Resident 7's History and Physical (H&P) dated 3/15/2026, the H&P indicated Resident 7 does not have the capacity to understand and make decisions.

During a concurrent observation and interview on 5/19/2026 at 10:45 a.m., with Licensed Vocational Nurse 3 (LVN 3), observed Resident 7 with a blue device wrapped around Resident 7's right arm. LVN 3 stated the device applied to Resident 7's right arm was a splint.

During a concurrent interview and record review on 5/21/2026 at 11:33 a.m., with the Director of Rehabilitation (DOR), reviewed Resident 7's care plans.

The DOR stated Resident 7 had a right elbow splint as an intervention under the occupational therapy treatment.

The DOR stated that Resident 7's right elbow splint and Occupational Therapy goals and interventions for Resident 7's right elbow splint were not documented in Resident 7's interdisciplinary care plan.

During a concurrent interview and record review on 5/21/2026 at 1:42 p.m., with the Minimum Data Set Nurse (MDS Nurse), the MDS Nurse stated the purpose of the care plan is to list the residents' concerns, problems, and the goals and interventions for each identified concern or problem.

The MDS Nurse stated a comprehensive care plan guides the resident's care.

The MDS Nurse stated that Resident 7's right elbow splint was not in Resident 7's interdisciplinary care plan.

The MDS Nurse stated that Resident 7's right elbow splint should have been in the interdisciplinary care plan for the care plan to be comprehensive.

During an interview on 5/21/2026 at 4:05 a.m., with the Director of Nursing (DON), the DON stated that a comprehensive care plan is a complete care plan.

The DON stated that not having Resident 7's right elbow splint in Resident 7's interdisciplinary care plan does not make Resident 7's care plan comprehensive.

The DON stated that a complete and comprehensive care plan is important to ensure care teams are all working together towards providing the best care to the residents.

During a review of the facility's policy and procedure (P&P) titled, Comprehensive Care Plans, last reviewed 1/14/2026, the P&P indicated, It is the policy of this facility to develop and implement a comprehensive person-centered care plan for each resident, consistent with resident's rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identifies in the resident's comprehensive assessment.The comprehensive care plan will be prepared by an interdisciplinary team, that includes, but is not limited to: f.

Other appropriate staff or professionals in disciplines as determined by the resident's needs or as requested by the resident.

Examples include, but are not limited to: iv.

Licensed therapists.

055146 05/22/2026

North Valley Nursing Center 7660 Wyngate St Tujunga, CA 91042

During a review of Resident 25's History and Physical (H&P) dated 2/18/2026, the H&P indicated Resident 25 had the capacity to understand and make decisions.

During a review of Resident 25's Minimum Data Set (MDS, a resident assessment tool) dated 2/24/2026, the MDS indicated Resident 25 did have the capacity to make himself understood and understand others, and was dependent (helper does all the effort) on staff for activities such as toileting, dressing, bathing and personal hygiene.

During a concurrent observation and interview on 5/18/2026 at 8:17 a.m., in Resident 25's room, Resident 25 stated the last time the podiatrist was at the facility, he was told he was not on the list to be trimmed. Resident 25 stated his fingernails, and toenails were too long, and his toenails were too yellow and thick and he is unable to care for them himself. Resident 25's fingernails and toenails appeared long, jagged, yellow and thick. Resident 25 stated only a podiatrist can cut his toenails because he has DM. Resident 25 stated he likes to be groomed especially his hair and his nails.

During a concurrent observation and interview on 5/18/2026 at 8:33 a.m., with the Infection Preventionist (IP), observed Resident 25's fingernails and toenails.

The IP stated Resident 25's fingernails and toenails were too long and the toenails appeared yellow and thick, especially the big toes.

The IP stated the right big toe had what appeared to be an ingrown nail affecting the outside wall of the right big toe.

During an interview on 5/22/2026 at 11:52 a.m., with the Director of Nursing (DON), the DON stated that having untrimmed or jagged nails can affect Resident 25's dignity because he is very alert and likes to be groomed.

During a review of the facility's policy and procedure (P&P) titled, Resident Rights, last reviewed on 1/14/2026, the P&P indicated residents have a right to a dignified existence.

During a review of the facility's P&P titled, Activities of Daily Living (ADLS), Supporting, last reviewed on 1/14/2026, the P&P indicated residents who are unable to carry out ADLs independently will receive the services necessary to maintain good nutrition, grooming, dressing, and personal and oral hygiene.

055146 05/22/2026

North Valley Nursing Center 7660 Wyngate St Tujunga, CA 91042

During a review of Residentˆ25's admission Record, the admission Recordˆindicatedˆthe facility admitted Residentˆ25ˆonˆ2/17/2026ˆwith diagnoses thatˆincludedˆtype 2 diabetesˆand need forˆassistanceˆwith personalˆcare and muscle weakness.ˆˆ During a review of Resident 25's History and Physical (H&P) dated 2/18/2026, the H&P indicated Resident 25 had the capacity to understand and make decisions.

During a review of Residentˆ25's Minimum Data Set (MDS, a resident assessment tool), datedˆ2/24/2026, the MDS indicated Residentˆ25ˆdidˆhave the capacity to make himself understood and understand others, and was dependentˆ(helper does all the effort)ˆon staff for activities such as toileting, dressing,ˆbathingˆand personal hygiene.ˆ During a concurrent observation and interview onˆ5/18/2026ˆatˆ8:20 a.m. in Resident 25's room, Resident 25 was lying in bed watching television. Resident 25ˆstatedˆthe last time the podiatrist was at the facility, he was told he was not on the list to be trimmed. Resident 25ˆstatedˆthere was an ingrown toenail on his right big toe that came back but it only bothers him if someone puts pressure on it. Resident 25 stated it has been a very long time since he had any treatment to his right big toe, and he has had the ingrown toenail for at least a week or longer. Resident 25 stated he told staff but did not remember who he told.

During a concurrent observation and interview onˆ5/18/2026ˆatˆ8:36ˆa.m. withˆthe Infection Preventionist (IP), the IP looked at Resident 25's feet andˆstated the right big toe hadˆwhat appeared to be anˆingrown nail affecting the outside wall of the right big toe.ˆThe IP stated there appeared to be some swelling and a dry crust on the left side of Resident 25's right big toe and needed to notify the doctor or podiatrist to get orders to provide treatment for it.

The IP stated treatment should have started as soon as the symptoms came back and that there should have been follow-up after the treatment ended on 5/2/2026 by either getting an order to continue treatment or document it was healed, if fully healed.

The DON further stated for residents with DM, licensed staff should be assessing their lower extremities for any wounds or suspected wounds daily and CNAs should be checking the resident's body for any wounds or discoloration when they are being showered or provided perineal (simple gentle cleaning of the genital area) care.

During an interviewˆ5/22/2026ˆat 11:59 a.m.ˆwithˆthe Director of Nursing (DON), the DONˆstatedˆthat Resident 25 has diabetes and wounds such as ingrown toenails should be addressed as soon as possible.

The DON stated the treatment nurses should have followed up after the orders to treat the same wound ended on 5/2/2026.

During a review of the facility's P&P, titled Podiatry Services, last reviewed 1/14/2026, the P&P indicated, it is the policy of the facility to ensure residents receive proper treatment and care within professional standards of practice to maintain mobility and good foot health.

During a review of the facility's P&P titled, Nursing Care of the Resident with Diabetes Mellitus, last reviewed 1/14/2026, the P&P indicated the purpose of these guidelines are to recognize, mange, and document the treatment complications commonly associated with diabetes .

Foot complications may be associated with prolonged, poorly controlled diabetes.

055146 05/22/2026

North Valley Nursing Center 7660 Wyngate St Tujunga, CA 91042

During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool), dated 5/9/2026, indicated Resident 1 was understood by others and was able to understand others and was dependent (helper does all the effort) on facility staff for toileting, bathing, lower body dressing and taking off/putting on footwear.

The MDS further indicated Resident 1 had a PU/PI and was using a pressure-reducing device for his bed.

During a review of Resident 1's Care Plan titled, At Risk for Development of PI, initiated on 1/31/26, the care plan indicated an intervention to use pressure reducing mattress.

During a review of Resident 1's Order Summary Report, the Order Summary Report indicated an order for LALM for wound management.

Charge Nurses to check proper placement and function.

Setting according to resident's weight every shift.

During a concurrent observation and interview on 5/18/2026 at 9:33 a.m., with Licensed Vocational Nurse 4 (LVN 4) in Resident 1's room, observed Resident 1 lying on his bed, flat with his LALM off.

LVN 4 stated the LALM should always be on when the resident is in bed to help prevent new or worsening PI/PU. LVN 4 stated Resident 1 had a PU on his sacrum, and it was important for the LALM to be on and functioning.

During an interview on 5/22/2026 at 1:37 p.m., with the Director of Nursing (DON), the DON stated Resident 1's LALM must be on at all times when he is in bed to prevent further breakdown.

The DON stated the licensed staff is in charge of making sure the LALM is functioning properly and at the right setting according to weight.

During a review of the facility's Policy and Procedure (P&P) titled, Pressure Injury Prevention Guidelines, last reviewed 1/14/2026, the P&P indicated to prevent pressure injuries to residents by repositioning and using pressure relieving /reducing and redistributing devices including but not limited to pressure relieving mattresses, wedges and pillows.

The P&P further indicated when physician orders are present, the facility will follow the specific physician orders.

055146 05/22/2026

North Valley Nursing Center 7660 Wyngate St Tujunga, CA 91042

During a review of Resident 7's Minimum Data Set (MDS - a resident assessment tool) dated 4/19/2025, the MDS indicated Resident 7 sometimes understood others and sometimes understands others.

The MDS indicated Resident 7 was dependent (helper does all of the effort) with activities of living (ADL - routine activities such as bathing, dressing, and toileting a person performs daily).

The MDS indicated Resident 7's was dependent for all mobility.

During a review of Resident 7's History and Physical (H&P) dated 3/15/2026, the H&P indicated Resident 7 does not have the capacity to understand and make decisions.

During a concurrent observation and interview on 5/18/2026 at 10:20 a.m., with Resident 7, observed Resident 7 lying in bed. Resident 7 did not directly respond to questions and instead spoke about unrelated topics.

During a concurrent interview and record review on 5/20/2026 at 10:27 a.m., with the Assistant Director of Nursing (ADON), reviewed Resident 7's care plans.

The ADON stated that she reviewed Resident 7's care plans and did not find a care plan for dementia.

The ADON stated Resident 7 had a diagnosis of dementia and should have a care plan for dementia interventions tailored to address Resident 7's needs.

The ADON stated a care plan is the blue print and is the guide that shows the care for the resident with the specific condition and situation.

The ADON stated residents with dementia have impaired cognitive status and require specific interventions and approach with their care.

During an interview on 5/21/2026 at 4:05 p.m., with the Director of Nursing (DON), the DON stated a care plan is the foundation for a resident's overall plan of care.

The DON stated that there should be a specific care plan for dementia, created specifically for the resident.

The DON stated interventions within these care plans must address residents' cognitive needs.

The DON stated that the care plan identifies problems, establishes goals and interventions, and facilitates evaluation to ensure intervention effectiveness, requiring adjustments when necessary.

The DON stated that the absence of a care plan for dementia can result in delays in care and unmet resident needs.

During a review of the facility's policy and procedure (P&P) titled, Dementia Care last reviewed 1/14/2026, the P&P indicated, It is the policy of this facility to provide the appropriate treatment and services to every resident who displays signs of, or is diagnosed with dementia, to meet his or her highest practicable physical, mental, and psychosocial well-being.The facility will assess, develop, and implement care plans through an interdisciplinary team (IDT) approach that includes the resident, their family, and/or resident representative, to the extent possible.

055146 05/22/2026

North Valley Nursing Center 7660 Wyngate St Tujunga, CA 91042

During a concurrent observation and interview on 5/18/2026 at 8:30 a.m., with [NAME] 1 in the ice machine room, observed a dark greenish and black residue when the inside bin and door of the ice machine were wiped with a clean paper towel. [NAME] 1 stated the residue was dust and if ice gets contaminated it can cause residents' illnesses.

During a concurrent observation and interview on 5/18/2026 at 2:56 p.m., with the Maintenance Supervisor (MS) in the ice machine room, observed a light brown and black residue collected when the inside of the ice bin, door molding, and the door were wiped with a clean paper towel.

The MS stated it was dust, and the ice machine should be kept clean to prevent infections in residents.

During a review of the Maintenance-Ice Machine Cleaning Schedule log, the ice machine was last cleaned on 4/24/2026.

During a review of the facility's policy and procedure (P&P) titled, Ice Machine Cleaning Policy, revised 8/18/2025, the P&P indicated there should be a focus on cleaning the door molding and the lid of the machine to ensure there are no rust or calcium deposits. 2.

During a concurrent observation and interview on 5/20/2026 at 12:26 p.m., with the Registered Dietitian (RD) in the kitchen, the temperatures of lunch drinks were tested: - The temperature of whole milk from cups in three trays was measured: the first tray's cup registered at 64 F, the second tray's cup at 50.5 F, and the third tray's cup at 43 F. - The temperature of apple juice from one cup tested was measured at 56.8 F. - The temperature of orange juice from one cup tested was measured at 62.4 F.

The RD stated drinks served to residents need to be lower than 50 F and served within two hours if the temperature is in the danger zone (bacterial growth and/or toxin production can occur when food remains in temperatures between 41 F and 135 F for too long).

The RD stated residents can get foodborne illness if the drinks are not kept within safe temperature levels.

During an interview on 5/20/2026 at 12:56 p.m., with the Kitchen Supervisor (KS), the KS stated lunch drinks are pre-filled at 6:00 a.m. and kept refrigerated until 10:00 a.m., then put in the freezer until 11:30 a.m. when they start preparing for tray line (a system of food serving in which a tray is moved along an assembly line to ensure a resident gets their prescribed diet).

The KS stated the kitchen staff maintain the drinks in ice trays during tray line, check temperature, and log temperature in the Food Temperature Chart.

The KS stated the drinks stayed out too long and were not maintained under 41 F.

During a concurrent interview and record review on 5/20/2026 at 2:35 p.m., with the RD, reviewed the facility's policy and procedure titled, Food Safety and Food Storage, revised 11/4/2024.

The P&P indicated, Maintain food at proper temperature and out of the Danger Zone.

The RD stated the lunch drinks were not maintained out of the danger zone.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE

055146 05/22/2026

North Valley Nursing Center 7660 Wyngate St Tujunga, CA 91042

During a review of Resident 48's Minimum Data Set (MDS - a resident assessment tool) dated 3/17/2026, the MDS indicated Resident 48 can make herself understood and understand others.

The MDS indicated Resident 48 was dependent (helper does all the effort) with shower/bath self, required substantial/maximal assistance (helper does more than half the effort) with lower body dressing, and required supervision or touching assistance (helper provides verbal cues and/or touching/steadying as resident completes activity) with oral hygiene, toileting hygiene, upper body dressing and eating.

During a review of Resident 48's History and Physical (H&P) dated 4/9/2026, the H&P indicated Resident 48 had the capacity to understand and make decisions.

During a concurrent observation and interview on 5/18/2026 at 11:35 a.m., with Resident 48, a female staff entered Resident 48's room and reached into a bag that was resting on a chair next to Resident 48's bed and quickly left the room. Resident 48 stated the bag belongs to her nurse. Resident 48 stated her nurse asked if she could leave her bag in Resident 48's room because Resident 48 stated, I guess they have some problems where staff can leave their things, not sure what problems.

During an interview on 5/18/2026 at 12:00 p.m., with Resident 48 in the presence of the Director of Nursing (DON), Resident 48 stated the bag on the chair next to her bed is CNA 1's lunch bag. Resident 48 stated, She always comes and brings it here.

She sometimes leaves her sweater too.

During an interview on 5/18/2026 at 12:05 p.m., with the DON, the DON stated the facility provides a designated space where staff can store their belongings.

The DON stated that staff should not keep any personal belongings in residents' rooms.

The DON explained that staff's personal items brought into resident's room pose an infection control risk because the contents or cleanliness of those items are unknown.

The DON stated that personal items may carry microorganisms that could potentially cause infections to the residents.

During a review of Resident 48's care plan (a document that outlines a resident's healthcare needs, goals, and the interventions planned to achieve those goals) titled, The resident has impaired immunity related to chronic illness initiated 10/24/2025, the care plan indicated the resident is at risk for contracting infections due to impaired immune status.

Keep the environment clean and people with infections away.

During a review of the facility's policy and procedure (P&P) titled, Infection Prevention and Control Program, last reviewed 1/14/2026, the P&P indicated, The facility has established and maintains an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and help prevent the development and transmission of the communicable diseases and infections per accepted national standards and guidelines .

All staff are responsible for following all policies and procedures related to the program.