Ladera Center

In the surveyor’s words

From the most serious findings on record at Ladera Center, in the surveyor’s own words.

• Immediate jeopardy, patternF684Sep 6, 2023

  Based on observation, interview, and record review the facility failed to provide quality care for 5 (R #29, 38, 61, 65 and 81) of 5 (R #s 29, 38, 61, 65 and 81) residents reviewed by not monitoring and treatment of wounds. This deficient practices could likely cause a decline in residents' health and well-being if physician orders are not followed, wounds could likely become infected causing sepsis (blood infection), osteomyelitis (bone infection) and/or other medical conditions could likely worsen.The findings are: A. […]

• Immediate jeopardy, isolatedF580Oct 28, 2024

  Based on record review and interview, the facility failed to notify the medical provider (Physicians and Nurse Practitioners) of a change in condition in which a resident with a history of myocardial infarction (MI; heart attack) reported chest pain for 1 (R #112) of 1 (R #112) residents reviewed for provider notification. If the facility fails to notify the provider of intermittent (not continuous) chest pain for a resident with prior history of MI (a major risk factor for having another MI), then it could likely delay the resident receiving necessary testing to determine if the resident requires life-saving medical intervention. This deficient practice likely contributed to the passing of R #1. The findings are: A. […]

• Immediate jeopardy, isolatedF684Oct 28, 2024

  Based on record review and interview, the facility failed to provide quality care to 1 (R #112) of 1 (R #112) residents when they failed to properly assess a resident with history of myocardial infarction (MI; heart attack) ) after the resident reported chest pains. If the facility fails to properly assess a resident who reports chest pains, then the resident may experience unidentified life-threatening conditions such as a heart attack. This deficient practice likely contributed to the passing of R #1 within the hour of reporting chest pain. The findings are: A. […]

• Immediate jeopardy, isolatedF760Oct 31, 2023

  Based on record review and interview, the facility failed to ensure medications were administered as ordered by the physician for 1 (R #11) of 3 (R # 11, 12, 13) resident reviewed for medications. This deficient practice resulted in R#11's pulmonary embolism [blood clots in the lungs (PE)] getting worse since the last CT scan (medical imaging technique used to obtain detailed internal images of the body) on 09/08/23 putting resident at increased risk for stroke and blockage of blood flow to the heart which could result in death. The findings are: A. […]

• Actual harm, patternF600Sep 6, 2023

  Based on record review, observation, and interview, the facility failed to prevent resident to resident sexual abuse and to protect multiple residents from observing ongoing sexual behaviors and verbal abuse for 6 (R #3, 29, 31, 45, 87 and 109) of 6 (R #3, 29, 31, 45, 87 and 109) residents reviewed for abuse. This deficient practice likely resulted in psychosocial distress (unpleasant emotions associated with a highly stressful environment) for the residents who observed the behavior; and for R #3 being uncomfortable around R #104. The findings are. A. On 08/27/23 at 4:45 pm, an observation revealed R #104 sat in the dayroom with a staff member next to him. B. […]