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F0559
D

Failure to Provide Advance Written Notice and Documentation for Room Changes

Los Angeles, California Survey Completed on 08-06-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to honor a resident's right to receive advance written notice and proper documentation before room changes occurred. Specifically, a resident with dementia and anxiety disorder, who required varying levels of assistance with daily activities, was moved to different rooms on four separate occasions. On each occasion, the responsible party (RP) was not notified in advance, and no written notice was provided explaining the reason for the room change. Additionally, there was no documentation in the resident's medical record regarding the room changes or the notification of the RP. Interviews with facility staff revealed inconsistencies in the notification process. The director of staff development confirmed that the RP should have been notified and consent obtained prior to any room change, but could not find documentation to support this. The social worker stated that notifications were made via text messages and that she kept a binder for room changes, but admitted that written notices were not provided and that documentation in the medical record was lacking. The facility's own policy required advance notice and documentation of room changes, which was not followed in these instances.

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