Schmitt Woodland Hills

NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY Number of residents sampled:15Number of residents cited: 2 OF 15 SAMPLED Based on observation, record review and staff interview, the facility did not ensure the resident's care plan was updated to reflect current care needs for 2 Resident (R33 and R41) of 15 sampled residents. R33's care plan reflected R33 should always have bilateral hand splints on except for at mealtime. Surveyor made observations of R33 without hand splints on. Staff had discontinued hand splints and started using washcloths in place of hand splints and had not updated the care plan. R41's care plan contained precautions from a Norovirus outbreak that occurred in the facility from December into January. The care plan was not discontinued once the outbreak was over. R41's care plan also contained a care plan for the use of an antidepressant which R41 is no longer taking. Findings: Facility policy titled Comprehensive Care Plan, last revised 1/2026 states in part. Policy: It is the policy of this facility to develop and implement a…

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 did not ensure residents with limited range of motion, received appropriate treatment and services to increase range of motion/mobility and/or to prevent further decrease in range of motion/mobility for 1 of 2 residents (R33) reviewed for range of motion (ROM).R33 did not receive her bilateral hand splints/wash clothes, cervical pillow per comprehensive care plan and therapy recommendations.This is evidenced by:The facility policy entitled Prevention of Decline in Range of Motion, dated 1/10/26, states, in part: . Policy: Residents who enter the facility without limited range of motion will not experience a reduction in range of motion unless the resident's clinical condition demonstrated that a reduction in range of motion is unavoidable.Policy Explanation and Compliance Guidelines:1. The facility in collaboration with the medical director, director of nurses and as appropriate, physical/occupational consultant shall establish and utilize a…

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 did not ensure a resident with a catheter receives appropriate treatment and services to prevent urinary tract infections for 1 of 1 resident (R6) reviewed for catheter care.Staff failed to perform proper hand hygiene with R6's catheter care. Staff did not perform hand hygiene in between removing soiled dressing, cleansing catheter site, and applying new dressing. Evidenced by:The facility policy entitled Hand Hygiene, dated 2023, states, in part: . Policy: All staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors.Policy Explanation and Compliance Guidelines:1. Staff will perform hand hygiene when indicated, using proper technique consistent with accepted standards of practice.2. Hand hygiene is indicated and will be performed under the conditions listed in, but not limited to, the attached hand hygiene table.-Before and after handling clean or soiled dressings, linens,…

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 Number of residents sampled:15Number of residents cited:1 o2 for hospiceBased on interview and record review, the facility did not ensure hospice collaboration and communication processes were established to ensure continuity of care between hospice and the facility for 1 of 2 resident (R1) reviewed for hospice.R1's current hospice plan of care was not available to facility staff.This is evidenced by: The facility's Coordination of Hospice Services policy, reviewed/revised 1/2/26, states, in part: .3. The plan of care will identify the care and services that each entity will provide in order to meet the needs of the resident and his/her expressed desire for hospice care. The hospice provider retains primary responsibility for the provision of hospice care and services that are necessary for the care of the resident's terminal illness and related conditions. The facility retains primary responsibility for implementing those aspects of care that are not related to the duties of hospice. R1 was admitted to 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.

Based on observation, interview and record review, the facility did not store, prepare, distribute and serve food in accordance with professional standards for food service safety. This has the potential to affect the facility census of 35. A kitchenette dishwasher was not registering the correct wash and rinse temperatures. Facility staff were observed touching multiple items in the kitchenette while serving and handling food without performing proper hand hygiene. Evidenced by: The 2022 FDA (Food and Drug Administration) Food Code states under 4-501.110 Mechanical Warewashing Equipment, Wash Solution Temperature and 4-501.112 Mechanical Warewashing Equipment, Hot Water Sanitization Temperatures state that wash temperatures of a high temperature sanitizing dishwasher must reach 160 degrees Fahrenheit, and the rinse temperature must reach 180 degrees Fahrenheit. The facility's policy titled, High Temperature Dish Machine Temperature Testing states that dietary staff will test high temperature dish machines to ensure the thermostat/machine is reaching the correct temperature. 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 observation, interview and record review, the facility did not ensure that all residents are clinically appropriate to self-administer medications for 1 of 6 residents (R4) observed during medication pass. R4 was observed to have her medications left at bedside. This is evidenced by: The facility policy entitled Resident Self-Administration of Medication, with a date reviewed 11/26/24, states, in part: . Policy: It is the policy of this facility to support each resident's right to self-administration medication. A resident may only self-administer medications after the facility's interdisciplinary team has determined which medications may be self-administered safely. Policy Explanation and Compliance Guidelines: 1. Each resident is offered the opportunity to self-administer medications during the routine assessment by the facility's interdisciplinary team. 2. Resident's preference will be documented on the appropriate form and placed in the medical record . 4. The results of the interdisciplinary team…

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 protect 1 of 35 residents (R19's) right to be free from verbal/mental/emotional abuse by a CNA (Certified Nursing Assistant). R19 stated CNA E was rude and demeaning to her, yelled at her, and was rough with her during AM (morning cares). R19 stated she was treated like a dog, or worse than a dog, treated like dirt, because she wouldn't treat a dog that way. Evidenced by: Facility policy titled Reporting Resident Abuse, Neglect, and Exploitation, dated 9/17/2007, with last revision date of 9/12/2024, states in part: .All allegations of resident/client physical, mental or sexual abuse, neglect, mistreatment . are to be reported to one's supervisor immediately . Incidents will be reported to the Administrator and licensing agency as required . Definitions: 1. Abuse: The willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain, or mental anguish . Verbal Abuse: The use of oral, written or…

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 did not ensure that all alleged violations involving abuse, neglect, exploitation, or mistreatment are reported immediately, but no later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse to the appropriate agencies for 1 of 1 abuse allegations of residents (R19). R19 reported an abuse allegation involving CNA E (Certified Nursing Assistant) that occurred on 10/26/24. This incident was reported to NHA A (Nursing Home Administrator), DON B (Director of Nursing), and CSW H (Certified Social Worker), but was not reported to the state agency. Evidenced by: Facility policy titled Reporting Resident Abuse, Neglect, and Exploitation, dated 9/17/2007, with last revision date of 9/12/2024, states, in part: .All allegations of resident/client physical, mental or sexual abuse, neglect, mistreatment . are to be reported to one's supervisor immediately . Incidents will be reported to the Administrator and licensing agency as…

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 did not ensure all alleged allegations of abuse were thoroughly investigated for 1 of 1 resident (R19) reviewed for abuse. On 10/28/24, the facility became aware R19 reported an allegation of verbal/mental abuse by a Certified Nursing Assistant (CNA); the facility did not conduct a thorough investigation. Evidenced by: Facility policy titled Reporting Resident Abuse, Neglect, and Exploitation, dated 9/17/2007, with last revision date of 9/12/2024, states, in part: .All allegations of resident/client physical, mental or sexual abuse, neglect, mistreatment . are to be reported to one's supervisor immediately . Incidents will be reported to the Administrator and licensing agency as required. A full investigation will follow and be completed within 5 working days . Definitions: 1. Abuse: The willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain, or mental anguish . Verbal Abuse: The use of oral, written…

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 did not ensure that each resident receives food and drink that is palatable and at a safe and appetizing temperature for 1 of 12 sampled residents (R19) and 2 supplemental residents (R34 and R29). R19, R29, and R34 voiced concerns of food being dry and cold. 1 of 1 test trays were noted to have dry pork served. Evidenced by: The facility policy, titled Dining Room Service, dated 2019, states in part: . Meals will be served promptly to maintain adequate temperature and appearance . Example 1 R19 was admitted to the facility on [DATE]. Her most recent Minimum Data Set (MDS), with an ARD (Assessment Reference Date) of 11/7/24, indicates her cognition is intact with a Brief Interview of Mental Status (BIMS) of 15 out of 15. On 11/25/24 at 10:58 AM, Surveyor interviewed R19 who indicated the food is so dry, particularly the pork, that at times it is inedible. Example 2 R29 admitted to the facility on [DATE]. Her most recent MDS with an ARD of 11/7/24 indicates her…

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.