Rosemead Healthcare Center

In the surveyor’s words

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

• Actual harm, isolatedF689Aug 5, 2024

  Based on observation, interview, and record review, the facility failed to provide care and services to prevent a fall (move downward, typically rapidly and freely without control, from a higher to a lower level) for one of two sampled residents (Resident 1) by failing to: 1. Ensure Certified Nursing Assistant (CNA) 1 provided two-person physical assistance (help from two persons) to transfer (moving a resident from one place to another) Resident 1 from the bed to the shower chair (a seat for the tub or shower) when CNA 1 used the Hoyer lift (a mechanical device used by staff to lift and transfer residents from a bed to a chair or one location to another). 2. […]

• Actual harm, isolatedF689Mar 1, 2024

  Based on observation, interview, and record review, the facility failed to provide supervision during a smoking session (when a group of residents gathered to smoke) for two of two sampled residents (Residents 1 and 2), while Residents 1 and 2 were smoking at the facility's patio area. Resident 2 pushed a metal table and hit Resident 1's right lower leg and the facility's staff (Receptionist 2) did not notice/intervene. As a result, on 2/19/2024 at 9:15 pm, Resident 1 sustained a laceration (a wound when skin, tissue, and/or muscle was torn or cut open) on Resident 1's right lower leg measuring 14.3 centimeter (cm-unit of measurement) in length, by 1.9 cm in width and by 0.2 cm in depth. […]

• No harm, potential for more than minimal, widespreadF836Feb 10, 2023

  Based on observation, interview, and record review, the facility failed to be licensed under State law. The facility has been operating with an expired license, dated [DATE]. This deficient practice of operating with an expired license could have a negative effect and threaten the welfare, safety and health of the patients. Finding: On [DATE], upon entering the facility, it was observed that the facility's license was posted at the consumer board, near the lobby. A closer observation of this license showed that it had an expiration date of [DATE]. On [DATE], at 8:30 am, an interview was conducted with the Business Office Manager (BOM) regarding the expired license. The BOM stated the facility paid the outstanding balance of $75,883.50 two months ago. […]

• No harm, potential for more than minimal, patternF558Mar 27, 2026

  Based on observation, interview, and record review the facility failed to ensure the call light (an alerting to assist a resident when needed) was within reach and appropriate to the patient's physical ability for three of three sampled residents (Residents 10, 14, and 26). These failures had the potential to result in a delay in meeting Residents 10, 14, and 26's needs for assistance and placed the residents at risk for a fall, injury or accident.Findings: a. During a review of Resident 10's admission Record (AR), the AR indicated the facility admitted Resident 10 on 2/8/2024 and re admitted on [DATE] with diagnoses including hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body) and hemiparesis (one-sided muscle weakness) and Alzheimer's disease (a disease… […]

• No harm, potential for more than minimal, patternF677Mar 27, 2026

  Based on observation, interview, and record review, the facility failed to ensure one of one sampled resident (Resident 1) was provided with care and services to maintain personal hygiene and nail care, by failing to:1, Ensure Resident 1 was seen by a Podiatrist (a medical doctor who specializes in caring for feet and ankles) as indicated in the resident's care plan.2. Ensure Resident 1's feet were not dry and toenails were trimmed. These deficient practices had the potential to result in a negative impact on Resident 1's health, quality of life and self-esteem. […]