Whittier Hills Health Care Ctr

F 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

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

resident's cognition was intact (sufficient judgement and self-control to manage the normal demands of the environment). The MDS indicated that the resident was at risk of developing pressure ulcers/injuries. The MDS indicated treatments for Resident 1's skin and ulcer/injury included pressure reducing device for chair, pressure reducing device for bed, nutrition or hydration intervention, application of nonsurgical dressings, and applications of ointments/medications. The treatment did not include a turning/repositioning program.

During a review of Resident 2's Weight Summary dated 10/6/2025, the Weight Summary indicated the resident's weight was 215 pounds. During an observation in Resident 2's Room on 11/13/2025 at 12:12 PM, the resident's low air loss mattress analog pressure dial was pointed between 250 pounds and 300 pounds. During a concurrent observation and interview on 11/13/2025 at 1:36 PM, the TN stated the setting for Resident 2's low air loss mattress should have been between 200 and 215 pounds. The TN stated the setting for Resident 2 was not correct and if the resident was reaching for something the low air loss mattress could flip the resident because the mattress moves with the resident. During a concurrent

interview and record review of Resident 2's Physician's Order on 11/13/2025 at 1:40 PM, the TN stated the facility was not following the orders to set the resident's low air loss mattress according to Resident 2's weight but should have been. The TN stated the facility staff should have checked the low air loss mattress all the time or the resident could fall off the bed and have a fracture or bruise. During a concurrent

observation and interview of Resident 2's low air loss mattress on 11/13/2025 at 4:55 PM, the DON stated

the setting was not correct for the resident's weight but should have been. The DON stated if the setting was not correct Resident 2's wound could possibly reopen. During a review of the undated User Manual for Resident 1's Alternating Pressure Mattress Replacement System with Low Air Loss, the User Manual indicated the system was a High quality powered air support surface that was specifically designed for the prevention and treatment of pressure injuries while optimizing patient comfort. The User Manual indicated Effective pressure redistribution therapy, wound management and device selection should be based on the patient's specific clinical condition and complete assessment of needs.Support surfaces are not substitutes for turning, repositioning or functional weight shifts. The User Manual indicated the Analog Pressure Dial Adjust the dial to correspond to the patients' appropriate weight setting or comfort level. During a concurrent interview and record review with the DON of the facility's policy and procedure (P&P) titled Skin and Wound Monitoring and Management dated December 2023, the P&P indicated Braden Scale for pressure injury risk should be completed on admission, weekly for the first four (4) weeks after admission, then quarterly and whenever there is a change in the resident's condition. The P&P indicate for prevention Reposition the resident. The DON stated the facility was not following the policy but should have been because the risk factors would be for the residents' wound to reopen or worsen. During a review of the facility's P&P titled Comprehensive Person-Centered Care Planning dated December 2023, the P&P indicated It is the policy of this facility that the interdisciplinary team (IDT) shall develop a comprehensive person-centered care plan for each resident that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental and psychosocial needs that are identified in the comprehensive assessment.

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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

11/13/2025

NAME OF PROVIDER OR SUPPLIER

STREET ADDRESS, CITY, STATE, ZIP CODE

Whittier Hills Health Care Ctr

10426 Bogardus Ave Whittier, CA 90603

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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

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

she did not know how Resident 2's physician appointment was inputted by mistake into Resident 1's medical record, in which SSD inputted the appointment herself. SSD stated there must have been a glitch (malfunction or irregularity) in the system, since SSD could not explain how Resident 1 was scheduled for

an appointment instead of Resident 2. During an interview on 11/13/2025 at 1:44 PM with Registered Nurse (RN 1), RN 1 stated Resident 1 should not go to appointments by herself unless it was requested by RP 1. RN 1 stated if RP requested for Resident 1 to travel alone, the nurse assigned to Resident 1 should have called RP 1 to verify their request and, should have called RP 1 before Resident 1 left the facility to confirm they were at the agreed upon location and let them know Resident 1 would be leaving the facility.

RN 1 stated Resident 1's nurse should have notified the transportation driver about Resident 1's diagnosis to ensure Resident1 would not be left alone or unattended. During an interview on 11/13/2025 at 3:53 PM with Director of Nursing (DON), DON stated the nurse for Resident 1 should have called Resident 1's RP

before Resident 1 left the facility to let RP 1 know Resident 1 was about to leave the facility, and to confirm that RP 1 would be waiting for Resident 1 at the doctor's office. During a review of the facility's Policy and Procedure (P&P) Out on Pass or Leave of Absence, with a revision date of 1/2022, the P&P indicated the following information It is the policy of this facility that continuity of care during resident leave of absence or while out on a pass will be maintained. Furthermore, the facility further stated Purpose: to provide a mechanism for continuity of care while a resident is away from the Facility for short periods.

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