Federal Nursing-Home Survey Record
PAVILION ON PICO HEALTHCARE & WELLNESS CENTRE, LP
Does PAVILION ON PICO HEALTHCARE & WELLNESS CENTRE, LP have a federal violation or abuse history?
According to the public federal record on file with the Centers for Medicare & Medicaid Services (CMS), PAVILION ON PICO HEALTHCARE & WELLNESS CENTRE, LP (CCN 055160), in LOS ANGELES, CA, has federal inspection findings on its record.
In its current inspection cycle, CMS cited the facility for 16 deficiencies; the most serious carries scope/severity E on CMS's A–L scale — CMS's "potential for harm" tier, below actual harm. Citations from earlier inspection cycles appear in the dated timeline below as historical findings, not current ones. This page restates the federal record as published by CMS and draws no conclusion of its own. Federal nursing-home surveys are conducted on a recurring cycle by state survey agencies acting on CMS's behalf, and the figures on this page are compiled from CMS's published provider data, as on file with CMS; the federal record may understate what actually occurred, and inspection findings are point-in-time survey results, not a determination that any specific resident was harmed.
The Federal Record
The most recent federal inspection on file records no actual-harm or immediate-jeopardy citations for this facility.
Below is this facility's federal survey record as on file with CMS.
Scope & Severity — current cycle
Overall CMS star rating: this facility vs the CMS-published state average
This facility: 3 · CMS state average: 3.2
Deficiency timeline — full federal history
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Implement a program that monitors antibiotic use.
Provide and implement an infection prevention and control program.
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
Ensure that residents are fully informed and understand their health status, care and treatments.
Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Ensure each resident receives an accurate assessment.
Ensure services provided by the nursing facility meet professional standards of quality.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Ensure medication error rates are not 5 percent or greater.
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents.
29 citations from earlier inspection cycles — historical, not current (expand)
Ensure each resident must receive and the facility must provide necessary behavioral health care and services.
Prepare residents for a safe transfer or discharge from the nursing home.
Provide medically-related social services to help each resident achieve the highest possible quality of life.
Make sure there is a pest control program to prevent/deal with mice, insects, or other pests.
Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.
Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs.
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Dispose of garbage and refuse properly.
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Assess the resident when there is a significant change in condition
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Ensure that residents are free from significant medication errors.
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents.
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
PASARR screening for Mental disorders or Intellectual Disabilities
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Reasonably accommodate the needs and preferences of each resident.
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Assist a resident in gaining access to vision and hearing services.
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.
Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents.
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Document what happened
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