Infinity Care of East los Angeles

In the surveyor’s words

From the most serious findings on record at Infinity Care of East los Angeles, in the surveyor’s own words.

• Immediate jeopardy, patternF607May 11, 2025

  Based on observation, interview, and record review, the facility failed to implement their policy and procedure (P&P) for abuse (the willful infliction of physical or psychological harm or the knowing deprivation of goods or services that are necessary to meet essential needs or to avoid physical or psychological harm) prevention, reporting, and investigation for two of three sampled residents (Resident 1 and Resident 2) by failing to: 1. Report physical abuse (any intentional act causing injury or trauma to another person) by Resident 3 to Resident 2 within two hours from when the Activities Assistant (AA) witnessed Resident 3 punching (strike with a fist) Resident 2 on the chest while waiting inside the elevator on 4/15/2025. […]

• Immediate jeopardy, isolatedF689May 31, 2025

  Based on interview and record review, the facility failed to ensure one (1) of 1 sampled resident (Resident 1), who has a diagnosis of nontraumatic (not caused by trauma or injury to the body) intracerebral hemorrhage (ICH, also known as hemorrhagic stroke [medical emergency where bleeding occurs within the brain tissue]) in brain stem (the lower part of the brain that connects to the spinal cord [a tube of tissue that carries nerve signals from the brain to the rest of the body]), assessed with severe cognitive impairment (ability to think, remember and reason) for daily decision making, and at risk for elopement (a resident who is incapable of adequately protecting himself, and who departs the health care facility unsupervised and undetected) was supervised to prevent injury and did not… […]

• Immediate jeopardy, isolatedF600May 11, 2025

  Based on observation, interview, and record review, the facility failed to protect one of three sampled residents (Resident 1) right to be free from sexual abuse (non-consensual [without the person's permission] touching of one person for the sexual gratification of another) on 5/6/2025 by failing to ensure: 1. Resident 1 was protected from sexual abuse by Resident 3. On 5/6/2025, while Resident 1 was sitting on her wheelchair along the hallway in front of Room A, Resident 3 touched Resident 1 on her inner thigh and later Resident 3 was witnessed touching Resident 1's upper back by placing his hands inside Resident 1's shirt. 2. Resident 1 was protected from further abuse by Resident 3 when facility staff did not separate Resident 1 from Resident 3. […]

• Actual harm, isolatedF600Jan 23, 2026

  Based on observation, interview, and record review, the facility failed to protect one (1) of six (6) sampled residents (Resident 1) right to be free from sexual abuse (non-consensual [without the person's permission] sexual contact of any type with a resident who does not wish to engage in sexual activity or may not have the capacity to consent) when Resident 2 was observed playing with Resident 1's private part on 1/10/2026. This failure resulted in Resident 1 being sexually abused by Resident 2 on 1/10/2026 and had the potential to result in Resident 1 experiencing negative psychosocial effects (a person's mental, emotional, social and spiritual health and hopelessness) based on the reasonable person concept (refers to a tool to assist the survey team's assessment of the severity level… […]

• No harm, potential for more than minimal, widespreadF851Jun 12, 2025

  Based on record review and interview, the facility failed to submit the second quarter of 2025 Payroll Based Journal (PBJ- a system for healthcare facilities to submit staffing information. This system allows staffing information to be collected on a regular and more frequent basis than previously collected) for the month from 1/1/2025 to 3/31/ 2025 on the designated time. This deficient practice compromised the accuracy of the facility's staffing levels and potential for the facility to not be adequately staffed and/or have the necessary staff to provide care to meet the needs of all the residents in the facility. […]