Whittier Pacific Care Center

During a review of Resident 1 ' s Admission Record (Face Sheet), indicated the facility admitted Resident 1 on 1/25/2019 and readmitted her on 8/9/2024 with diagnoses that included muscle weakness, osteoarthritis (tissue in the joints break down over time) of the left ankle and foot, and unspecified dementia (a decline in mental function that affects a person ' s ability to think, remember, make decisions, and can interfere with their daily activities).

During a review of Resident 1 ' s History Physical Examination (HPE, a comprehensive physician ' s note regarding the assessment of the resident ' s health status), dated 11/30/2023, Resident 1 does not have the capacity to understand and make decision.

During a review of Resident 1 ' s Minimum Data Set (MDS, a standardized assessment and care screening tool), dated 8/3/2024, indicated Resident 1 had moderately impaired cognition ( ability to think and reason).

The MDS indicated Resident 1 required supervision (the helper provided verbal cues or contact guard assistance as resident completes the activity) when showering, set up assistance (the helper set ups or cleans up; resident completes activity) with personal hygiene, upper and lower body dressing, and personal hygiene, and independent when eating and putting on/taking off footwear.

The MDS indicated that Resident 1 did not have any falls since admission.

055764

Form Approved OMB

STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CLIA (X2) MULTIPLE CONSTRUCTION (X3) DATE SURVEY AND PLAN OF CORRECTION IDENTIFICATION NUMBER: COMPLETED A.

Building 055764 B.

Wing 08/16/2024

NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE

Whittier Pacific Care Center 7716 S Pickering Avenue Whittier, CA 90602