Las Flores Convalescent Hospital

In the surveyor’s words

From the most serious findings on record at Las Flores Convalescent Hospital, in the surveyor’s own words.

• Immediate jeopardy, widespreadF880Jan 4, 2022

  Based on observation, interview, and record review, the facility failed to implement interventions to prevent and control the spread of the corona virus ([COVID-19] an illness caused by a virus that can easily spread from person to person) per their mitigation plan (MP). The MP indicated the facility would provide and ensure the employees wear a facemask or respirator and other necessary personal protective equipment (PPE) when exposure to individuals with suspected or confirmed COVID-19 in accordance with the facility's respiratory protection program (N95 Respiratory Respirator policy) for 110 of 110 residents residing in the facility. The facility failed to: 1. […]

• Immediate jeopardy, isolatedF656Oct 17, 2024

  Based on interview and record review, the facility failed to implement care plan intervention to monitor routinely, one of three residents (Resident 1), to prevent from leaving the facility unsupervised by failing to specify: a. The type of supervision (the act of watching) Resident 1 needed after he eloped (when a resident who is cognitively, physically, mentally, emotionally, and/or chemically impaired leaves a care-giving facility or environment unsupervised, unnoticed, and/or prior to their scheduled discharge) from the facility on 6/19/2024 and 8/24/2024. b. […]

• Immediate jeopardy, isolatedF689Jun 1, 2024

  Based on observation, interview, and record review, the facility failed to ensure residents had an environment free of accident hazards (risk) for three (3) of 3 sampled residents (Residents 1, 2, and 3) who were smokers by failing to: 1). Ensure Resident 1 did not have a cigarette lighter on his bedside table on 5/29/2024 at 11:24 a.m. 2). Ensure Resident 2 did not have a lighter and two (2) cigarette sticks in her (Resident 2) purse on 5/29/2024 at 2:51 p.m. 3) Ensure Resident 3 did not have a lighter and 2 cigarette sticks while in the hallway, and at the bedside table on 5/30/2024 at 9:07 a.m. 4). […]

• Actual harm, isolatedF600Mar 5, 2026

  Based on interview and record review, the facility failed to: 1. Ensure Resident 1 was free from physical abuse when Resident 2 punched Resident 1 in the face.As a result, Resident 1 sustained nasal fractures (broken bones), a nosebleed and bump on the forehead which required a transfer to the general acute care hospital (GACH) for evaluation and treatment.Findings: a. During a review of Resident 1's face sheet (admission record), the face sheet indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including Diabetes Mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing), congestive heart failure (CHF-a heart disorder which causes the heart to not pump the blood efficiently, sometimes resulting in leg swelling), and major… […]

• Actual harm, isolatedF686Dec 5, 2025

  Based on interview and record review, the facility failed to ensure one of six sampled residents (Resident 1), did not develop pressure ulcer (localized, pressure-related damage to the skin and/or underlying tissue usually over a bony prominence [any point of the body where the bone is immediately below the skin surface]) at the facility. The facility failed to:1). Implement its policy and procedure (P&P) titled, Pressure Ulcer Prevention which indicated, the facility should develop a care plan for residents at risk for pressure ulcers specific to the resident's risk factors (something that increases the chance of developing pressure ulcer).2). Provide care and services to promote the prevention of pressure ulcer development as indicated in its P&P titled, Pressure Ulcer Prevention. 3). […]