Laurel Park Behavioral Health Center

In the surveyor’s words

From the most serious findings on record at Laurel Park Behavioral Health Center, in the surveyor’s own words.

• Immediate jeopardy, patternF609Feb 25, 2022

  Based on interview and record review, the facility failed to report allegations of exploitation (taking advantage of a resident for personal gain, using manipulation, intimidation, threats, or pressure) within 24 hours for three of three sampled residents (Residents 1, 2, and 3) to the California Department of Public Health (CDPH) in accordance with the facility's policy and procedure (P&P). On 2/18/2022, at 5:50 pm, Resident 2 told SSD that she and Resident 1 purchased marijuana (a green, brown, or gray mix of dried, crumbled parts from the marijuana plant which contains chemicals which act on your brain and can change your mood or consciousness) from Primary Counselor (PC) who was employed by the facility (unidentified date and time). […]

• Immediate jeopardy, patternF689Feb 25, 2022

  Based on interview and record review, the facility failed to supervise and ensure three of three sampled residents (Residents 1, 2, and 3) did not use and did not purchase marijuana (a green, brown, or gray mix of dried, crumbled parts from the marijuana plant which contains chemicals which act on your brain and can change your mood or consciousness), from the facility's Primary Counselor (PC). On 2/15/2022, at 1:12 pm, the facility's Social Services Director (SSD) found marijuana (a green, brown, or gray mix of dried, crumbled parts from the marijuana plant which contains chemicals which act on your brain and can change your mood or consciousness) inside Resident 1's room. […]

• Immediate jeopardy, isolatedF689Aug 13, 2025

  Based on observation, interview, and record review, the facility failed to ensure one of one sampled resident (Resident 1), who was on a [NAME]-Petris-Short (LPS, a California law enacted in 1969 that regulates the involuntary commitment of individuals with mental health disorders) conservatorship (a legal process where a court appoints a person to make certain decisions for an individual who was deemed gravely disabled [unable to provide for basic needs] due to a mental health disorder), did not elope (the act of leaving a facility unsupervised and without prior authorization) from a secure facility (a building, institution, or location designed and operated with features that physically restrict unauthorized access or the movement of individuals to prevent people from leaving or others… […]

• No harm, potential for more than minimal, widespreadF803Dec 14, 2023

  Based on observation, interview, and record review, the facility failed to ensure necessary dietary services were provided to 43 of 43 residents in the facility in accordance with the facility's Policy and Procedure (P&P) titled Menus, by failing to: A. Ensure the facility's Registered Dietitian (RD) reviewed and approved the menus for nutritional adequacy prior to the implementation of the menu changes on 12/11/23. B. Ensure the facility menus were followed, prepared in advance, and met the nutritional needs of residents. Findings: A. […]

• No harm, potential for more than minimal, patternF640Nov 14, 2025

  Based on interview and record review, the facility failed to complete and transmit the discharge minimum data set (MDS, a standardized assessment and care-screening tool) assessment in a timely manner for one of one sampled residents (Resident 48) and failed to complete and transmit the annual MDS assessment in a timely manner for two of two sampled residents (Resident 20 and Resident 43) as required by the Centers for Medicare & Medicaid Services (CMS is a federal agency that manages health care programs in the United States) Resident Assessment Instrument (RAI, a tool used by nursing homes to assess the needs, strengths, and preferences of residents) manual.These deficient practices resulted in a late completion and transmission of the MDS assessment to CMS Quality Improvement and… […]