Southern California Hosp At Culver City D/P SNF

Based on interview and record review, the facility failed to: 1. The facility failed to ensure annual competencies were signed and dated by 3 employees. This deficient practice had the potential to result in providing incompetent and inadequate care for all residents. Findings: During a record review of 5 randomly selected employee files, on 12/15/24, 8:07 a.m., Licensed Vocational Nurse 1, (LVN 1), LVN 1's Restraints, Skills Fair and Critical Clinical Alarm competencies was noted with missing employee and preceptor signatures. During a record review, on 12/15/24, 8:16 a.m., Licensed Vocational Nurse 2, (LVN 2), LVN 2's General Hiring Orientation form, Care of the Post-Op Bariatric Surgery Patient In-service quiz was noted with missing dates, and no facilitator's name or signature. During a record review of LVN 2's Nursing Intravenous (IV) Medication Mixing Skills Checklist, on 12/15/2024, at 8:23 a.m., the Nursing IV Medication Mixing Skills Checklist competency was incomplete with no date and the facilitator's name struck out. During a concurrent interview and record review, on…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and interview the facility failed to: 1. Ensure a thermometer was inside of the kitchen's walk-in refrigerator # 1. 2. Ensure frozen foods were dated and labeled in reach-in freezer # 1. This deficient practice had the potential to result in food expiration. Findings: During a concurrent observation and interview of the kitchen, on 12/14/2024, at 8:42 a.m., with the Sous Chef (SC), the SC stated the walk-in refrigerator was stored with vegetables and fruits. Upon observation, the SC stated there was no thermometer (an instrument for measuring and indicating temperature) in the walk-in refrigerator. The SC stated a thermometer was required to be inside of the refrigerator to monitor the temperature. The SC stated, I think someone took it out of the fridge, it was there yesterday. The SC stated the risk of not having thermometer in fridge could result in the temperature rising, spoiling food. During a concurrent observation and interview, on 12/14/2024, at 8:50 a.m., of the reach-in freezer,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY During an observation, interview, and record review the facility failed to: 1. Ensure one out of six sampled residents (Resident 8) had an indwelling catheter (a tube inserted into the bladder to drain urine) covered with a privacy bag. This deficient practice of not covering the indwelling catheter had the potential to make Resident 8 not feel humiliated (to feel ashamed). Findings: During a review of Resident 8's admission Record ([Face Sheet] front page of the chart that contains a summary of basic information about the resident), the Face Sheet indicated Resident 8 was initially admitted to the facility on [DATE]. During a review of Resident 8's History and Physical (H&P), dated 5/11/2024, the H&P indicated Resident 8 diagnoses were respiratory distress (difficulty breathing not getting enough oxygen), thyroid cancer (cancer that develops in the thyroid gland that produces hormones), neurogenic bladder (a condition when the brain, spinal cord, or nerves are damaged resulting in bladder control issues).…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to: 1. Ensure the survey results and complaint investigation reports in the previous three years were posted in a place readily accessible to the residents and public. This failure had the potential for residents, visitors, family members, or family representative not being able to examine and compare the previous survey results, and facility's deficient practice and how they were corrected. Findings: During a concurrent observation and interview on 12/14/2024 at 9:59 a.m., with the Director of Quality and Risk Management (DQRM) at nursing station hallway, the DQRM stated the survey results and complaint investigation reports by the California Department of Public Health ([CDPH] state licensing and certification agency) was not available at the nursing station hallway. The DQRM stated the survey results and complaint investigation reports was placed in a separate binder and kept at her office. The DQRM stated the facility never posted and made it available to the public the survey results and complaint…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to: 1. Complete and re-submit the Preadmission Screening and Resident Review ([PASARR - a tool to determine if the person had, or was suspected of having a mental illness, intellectual disability, or related condition) Level one (I) screening and refer one of two sampled residents (Resident 4) who had diagnoses of anxiety disorder (a condition that involves excessive and persistent feelings of fear, dread, and worry that can interfere with daily life), depression (a mood disorder that causes a persistent feelings of sadness and loss of interest), and psychosis (a severe mental condition in which thought, and emotions are so affected that contact is lost with reality), to the appropriate state-designated authority for PASARR Level two (II) evaluation and determination. This deficient practice had the potential for Resident 4 not to receive appropriate medical treatments for mental illness diagnoses. Findings: During a review of Resident 4's Face Sheet…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review the facility failed to: 1. Ensure one out of six sampled residents (Resident 5) ventilator tubing (the tubing carries oxygen and air to and from the patient) was labeled and dated. This deficient practice of not labeling and dating the respiratory tubing placed Resident 5 at risk for respiratory infection (infections that could affect parts of the body involved in breathing). Findings: During an observation on 12/14/2024 at 9:00 a.m. in Resident 5's room, there was no date on the ventilator tubing connected the ventilator (a machine that helps a patient breathe when they are unable to do so on their own) and to the resident tracheostomy (surgical procedure that creates an opening in the neck to help with breathing). During an interview on 12/14/2024 at 4:31 p.m. with Respiratory Therapist (RT) 1, RT 1 stated she had changed the tubing but did not put a date on the ventilator tubing. RT 1 stated it was important to place the date on the ventilator tubing after it is changed so we know how long it has been attached to the resident. RT…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure residents on tube feeding received treatment and care in accordance with professional standards of practice by failing to: 1. Elevate the head of the bed while receiving formula through the gastrostomy tube (a surgical opening fitted with a device to allow feedings to be administered directly to the stomach common for people with swallowing problems) for one of four sampled residents (Resident 4). This deficient practice had the potential to cause aspiration (inhalation of foreign materials) that can lead to pneumonia (lung infection) for Resident 4. Findings: During a review of Resident 4's Face Sheet (front page of the chart that contains a summary of basic information about the resident), the Face Sheet indicated, Resident 4 was admitted to the facility on [DATE]. The Face Sheet indicated, Resident 4's diagnoses included acute respiratory failure (a serious condition that makes it difficult to breathe on your own), and…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to: 1. Ensure intravenous ([IV] into or connected to vein) tubing was labeled and dated for one of two sampled residents (Resident 9) who was receiving IV antibiotic (drug that treats infection) treatment. This deficient practice had the potential to placed Resident 9 at risk for infection and IV therapy complications. Findings: During a review of Resident 9's Face Sheet (front page of the chart that contains a summary of basic information about the resident), the Face Sheet indicated, Resident 9 was admitted to the facility on [DATE]. The Face Sheet indicated Resident 9's diagnoses included tracheostomy (a surgical procedure that creates an opening in the neck into the windpipe to help a person to breathe) and anemia (a condition where the body does not have enough healthy red blood cells). During a review of review of Resident 9's Minimum Data Set ([MDS] - a resident assessment tool), dated 9/13/2024, the MDS indicated, Resident 9 was on…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation and interview, the facility failed to: 1. Ensure expired medication was not kept in the medication storage refrigerator. This deficient practice had the potential to result in administering expired medication. Findings: During a review of resident 16's admission Record, indicated Resident 16 was re-admitted to the on [DATE] with the diagnosis of Respiratory Failure (a serious condition that occurs when the lungs have difficulty getting enough oxygen into the blood). During an observation of the facility's Medication Storage room refrigerator, on [DATE], at 9:47 a.m., one medication was observed to be expired. The medication, Vancomycin, prescribed for Resident 16, was labeled with an expiration date and time of [DATE] at 7:30 a.m. During a concurrent observation and interview, on [DATE], at 9:51 a.m., with Registered Nurse 2 (RN 2), RN 2 stated the process of storing medication was to ensure whether a medication was to be refrigerated and check the expiration date. RN 2 stated the Vancomycin…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to: 1. Ensure one out six sampled residents (Resident 8) had completed laboratory ([labs] blood samples to assess a patient's health status) test. This deficient practice of not completing labs placed the resident at risk for not receiving accurate medication treatment. Findings: During a review of Resident 8's admission Record ([Face Sheet] front page of the chart that contains a summary of basic information about the resident), the Face Sheet indicated Resident 8 was initially admitted to the facility on [DATE]. During a review of Resident 8's History and Physical (H&P), dated 5/11/2024, the H&P indicated Resident 8 diagnoses were respiratory distress (difficulty breathing not getting enough oxygen), thyroid cancer (cancer that develops in the thyroid gland that produces hormones), neurogenic bladder (a condition when the brain, spinal cord, or nerves are damaged resulting in bladder control issues). During a review of Resident 8's Minimum Data Set…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to: 1. Ensure one out of six sampled residents (Resident 13) had dental services. This deficient practice of not providing dental services had the potential to for Resident 13 to develop a mouth infection (a group of infections that occur around the oral cavity). Findings: During a review of Resident 13's admission Record ([Face Sheet] front page of the chart that contains a summary of basic information about the resident), the Face Sheet indicated Resident 13 was initially admitted to the facility on [DATE] with the diagnose of dysphagia (difficulty swallowing). During a review of Resident 13's History and Physical (H&P), dated 9/12/2024, the H&P indicated Resident 13 diagnoses were peripheral vascular disease (is a slow and progressive narrowing of the blood flow to the arms and legs), chronic renal failure (is a condition where the kidneys are damaged) congestive heart failure ([CHF]- a heart disorder which causes the heart to not pump the blood…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on interview and record review, the facility failed to: 1. Ensure Quality Assurance Performance Improvement (QAPI- Quality Assurance and Performance Improvement-a data driven proactive approach to improvement used to ensure services are meeting quality standards) meetings were held quarterly (every 3 months). This deficient practice had the potential to result in systemic issues within the facility. Findings: During a concurrent interview and record review of the facility's QAPI binder, on 12/15/2024, at 2:28 p.m., with the Director of Quality and Risk Management (DQRM), the DQRM stated the facility's QAPI committee was to meet quarterly. The DQRM stated the last QAPI meeting was in December 2024. The DQRM stated the previous QAPI meeting before December 2024 was held in May of 2024. The DQRM stated a meeting should had been held in August 2024. The DQRM stated there was no meeting held in August/September 2024. The DQRM stated the risk of not meeting quarterly for QAPI meetings could result in systemic issues without improvements. During a review of the facility's policy and…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review the facility failed to: 1. Ensure one out of six sampled residents (Resident 5) ventilator tubing (the tubing carries oxygen and air to and from the patient) was labeled and dated. This deficient practice of not labeling and dating the respiratory tubing placed Resident 5 at risk for respiratory infection (infections that could affect parts of the body involved in breathing). Findings: During an observation on 12/14/2024 at 9:00 a.m. in Resident 5's room, there was no date on the ventilator tubing connected the ventilator (a machine that helps a patient breathe when they are unable to do so on their own) and to the resident tracheostomy (surgical procedure that creates an opening in the neck to help with breathing). During an interview on 12/14/2024 at 4:31 p.m. with Respiratory Therapist (RT) 1, RT 1 stated she had changed the tubing but did not put a date on the ventilator tubing. RT 1 stated it was important to place the date on the ventilator tubing after it is changed so we know how long it has been attached to the resident. RT…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview, and record review, the facility failed to ensure nursing professional standards were provided for two of three sampled residents (Resident 1 and Resident 3), when: 1. No documentation of an assessment (to evaluate a resident ' s health) was found in Resident 1 ' s electronic health record (EHR – a digital version of a resident ' s medical history) when Resident 1 had heart rate of 106 beats per minute (bpm – the normal range is between 60 to 100 bpm, an elevated heart rate is greater than 100 bpm and may indicate many problems such as pain, infection, or anxiety). This failure resulted in Resident 1 ' s elevated heart rate not being addressed for more than three hours from 8:19 p.m. to 11:38 p.m. 2. Resident 3 ' s range of motion services (ROM – activity aimed to improving movement of a specific joint) on 9/29/24 and 10/1/24 were not indicated as given in Resident 3 ' s EHR. This failure had the potential for Resident 3 to develop contractures (permanent tightening of muscles,…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review, the facility failed to ensure one of three sampled residents (Resident 1) was cared for by a health care clinician that has a current Basic Life Support (BLS, care that first-responders, healthcare providers and public safety professionals provide to anyone who is experiencing cardiac arrest [the heart stop functioning], respiratory distress or an obstructed airway) in accordance with the facility job description for Licensed Vocational Nurses. (LVN). LVN 1 who was assigned to work on the facility subacute unit (a unit that provide intensive care, but to a lesser degree than acute care), did not have a up to date BLS certification. This deficient practice had the potential of delayed provisions of emergency care for Resident 1 and the 39 residents in the subacute unit who wishes to have full treatment in a life-threatening situation. Findings: During a review of Resident 1 ' s History and Physical (H&P, the most formal and complete assessment of the resident and the…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on interview and record review the facility failed to provide prompt efforts to resolve grievances of residents voiced to the facility through the Resident Council Meetings for two of eighteen sampled residents (resident 9 and Resident 15) who used to attend to a monthly group meeting. This deficient practice resulted in unresolved residents' grievances related to delay in assistance for residents' care needs. Findings: a. During a review of Resident 9's admission record, the admission record indicated Resident 9 was admitted on [DATE], with a diagnosis that included traumatic brain injury (a disruption in the normal function of the brain caused by forceful bump, blow, or jolt to the head or body), tracheostomy dependent (a surgical opening in the neck for an airway), and neurogenic bladder (lack bladder control due to a brain, spinal cord, or nerve problem). During a review of Resident 9's minimum data set ([MDS] a standardized care assessment and care screening tool), dated 11/6/2023, the MDS indicated…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to ensure an activity program for five of five sampled residents (Residents 3, 9, 14, 15, and 16) who wanted to participate in activities. The failure to implement a plan to conduct activities in the absence of an activity coordinator placed the residents' mental, psychosocial, and emotional well-being at risk of feeling isolated and depressed. This deficient practice of not having an activity program meant the residents lacked substandard practice and care for their practical well-being. Findings: a. During a review of Resident 3's admission Record (face sheet), indicated an admission to the sub-acute unit on 4/01/2021. During a review, Resident 3's History and Physical (H&P), diagnoses included respiratory failure (the blood does not have enough oxygen) and tracheostomy (an incision to relieve an obstruction to breathing). During a review of Resident 3's Minimum Data Set ([MDS] a comprehensive assessment and care-screening tool), dated 11/16/2023, indicated Resident 3 had limited ability to make concrete…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

Based on observation, interview, and record review, the facility failed to assess the urine in the indwelling catheter tubing collecting bag for three out of eighteen sampled residents (Residents 9, 11, and 14). 1. Resident 11 had an indwelling catheter (inside the body that drains urine from the bladder into an outside bag) with noticeable sediment (accumulation of white blood cells) that was cloudy and without a privacy bag. 2. Resident 14 had a condom catheter (a soft latex applied over the penis that pushes urine through tubing) with noticeable sediment in the urine tubing with no privacy bag. 3. Resident 9 had an indwelling catheter with noticeable sediment in the urine tubing. This deficient practice placed Residents 9, 11, and 14 at risk for urinary tract infection ([UTI] when bacteria enter the urinary system and infect the urinary tract) or sepsis (a serious condition resulting from the presence of harmful microorganisms in the blood or other tissues that could lead to malfunctioning of various organs, shock, and death). Findings: 1a. During a review, Resident 11's…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to ensure two of 9 sampled residents' (Resident 7 and Resident 15) gastrostomy tube ([GT] tube placed directly into stomach to give direct access for supplemental feeding, hydration, or medicine) feeding formula was labeled with the date and time according to the facility's policy and procedure (P&P). This deficient practice had the potential to result in Resident 7 and Resident 15 receiving tube feeding formula over the expiration or maximum formula hang time (how long a tube feeding formula should hang safely prior to discarding or changing) and could adversely affect the resident's health and wellbeing. Findings: a. During a review of Resident 7's admission Record (Face Sheet), the Face Sheet indicated Resident 7 was admitted on [DATE], with diagnoses including dependence on respiratory (ventilator) status ( unable to wean off a ventilator and breathe independently), Dysphagia (difficulty swallowing) and GT. During a review of Resident 7's…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Based on observation, interview and record review, the facility failed to: 1. Ensure stored food were labeled with open date and expiration date. 2. Ensure expired food were not stored in the kitchen and accessible for use in preparing foods in accordance with professional standards for food service safety. This practice had the potential to result in foodborne illnesses which can affect the health and safety of all residents in the facility. Findings: a. During a concurrent observation and interview on 12/2/2023 at 8:00 a.m., of the cereal shelf, there were two (2) open plastic bins with 2 individual cereal boxes without open date and expiration date. On the kitchen counter, a seal plastic container with sesame seeds had no open date and expiration date. On the bread metal shelf, one open bread load had no open date. Kitchen Supervisor (KS) KS stated, there were different persons every time we received products and they forget to place an open date when cereals were removed from the big boxes. KS stated, any…

This is the beginning of the surveyor’s statement, cut to keep the page readable — the full 2567 continues past this point and often ends with the findings that matter most, such as whether an immediate jeopardy was removed before the surveyors left. The complete statement of deficiencies is a public record: request it from your state survey agency, or ask the home for its 2567 and plan of correction — it must make them available to residents and families.