Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around November 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Lomita Post-acute Care Center during CMS and state inspections, most recent first.
Surveyors found that staff failed to respond promptly to call lights and provide timely ADL assistance for three cognitively intact residents who required varying levels of help with toileting, transfers, and incontinence care. One resident reported waiting 30–60 minutes at night for assistance with bathroom use and water, and another reported similar delays for incontinence care. A third resident, fully dependent for toileting and always incontinent, was observed with the call light on requesting to urinate while an ADM and a CNA instructed her to void in her brief instead of offering a bedpan or bedside commode, despite her stating she was continent and disliked being left wet. Staff interviews, including a CNA, an LVN, and the DON, confirmed that all staff were expected to answer call lights promptly and that the observed and reported delays and directions to use briefs were inconsistent with facility policies on call light response and perineal care.
A resident with a history of stroke and left side paralysis, who was dependent on staff and had a care plan for pain management, reported pain in her left arm and hand during showering and transfer. Staff did not provide timely pain relief or report the pain as required, resulting in unmanaged pain despite facility policy and care plan interventions.
A facility failed to post a contact precaution sign indicating necessary PPE for visitors of a resident who tested positive for C. Diff. Although staff instructions were present, visitor instructions were missing, which was acknowledged by an RN. The resident had a history of surgical amputation and type 2 DM, and tested positive for C. Diff. Facility policies emphasized infection control, but the lack of visitor signage represented a policy adherence failure.
The facility failed to maintain an effective pest control program, leading to a gnat infestation in various areas, including residents' rooms and the kitchen. Observations revealed unsanitary conditions, such as undated food containers and a strong odor in the shared refrigerator. Staff and family members reported gnats emerging during meal times, with potential contamination risks for residents. Despite efforts to address the issue, the facility's response was delayed, and pest control measures were not promptly implemented.
The facility failed to complete accurate PASARR assessments for three residents diagnosed with mental illnesses prior to admission. These residents were prescribed psychotropic medications, but their PASARR assessments did not reflect their diagnoses, potentially impacting their care. The DON acknowledged the inaccuracies, which could delay necessary treatment and services.
A resident's hearing status was inaccurately documented as adequate in the MDS, despite being hard of hearing and requiring specific communication interventions. Interviews with staff and the resident confirmed the need for hearing aids, and both the MDS Nurse and DON acknowledged the error, emphasizing the importance of accurate MDS documentation.
A resident on Eliquis for venous thrombosis and undergoing renal dialysis was not monitored for bleeding as required by their care plan. Despite the care plan's directives and the facility's policy on anticoagulation management, there was no documentation of monitoring for signs of bleeding, leading to a deficiency in care.
A resident with a hip fracture and other medical conditions was not provided necessary assistance with ADLs, leading to feelings of abandonment. The resident requested a shower due to a wet diaper, but the CNA encountered difficulties with the transfer and did not follow through with promised care. Lack of communication and coordination among staff contributed to the unmet needs.
A resident with a history of a ruptured popliteal artery did not receive a timely venous and arterial doppler test as ordered by the physician due to the unavailability of an x-ray technician. The facility failed to notify the physician of the delay, and there was inadequate monitoring of a hematoma on the resident's left leg, as it was only visually checked without accurate measurement. This lack of communication and assessment could have delayed diagnosis and treatment.
A resident with anxiety and major depressive disorder was not provided access to necessary hearing services despite being hard of hearing. The care plan noted communication issues, and staff confirmed the resident's need for hearing aids. The facility's policy required assessment for ancillary services, but the resident did not receive the needed audiology services.
A resident at risk for falls had a bedside table placed on top of landing pads intended to cushion falls, posing a potential injury risk. Facility staff acknowledged the inappropriate placement and the potential hazard it created.
The facility failed to maintain up-to-date employee files, resulting in missing TB tests, skills competency checklists, performance evaluations, health exams, and background checks for several staff members. The DSD and DON acknowledged these deficiencies, which could impact resident care and safety.
Two residents were affected by the facility's failure to monitor and justify medication use. One resident was on methenamine without proper testing or history of UTIs, risking antibiotic resistance. Another resident on Eliquis lacked monitoring for adverse effects, risking bleeding and anemia. Facility policies on medication management were not followed.
Two residents were administered psychotropic medications without proper non-pharmacological interventions or reevaluation of medication appropriateness. One resident received Ativan without documented anxiety episodes or attempts at non-pharmacological interventions, while another resident's medication regimen was not reviewed despite recommendations. Facility policies on medication administration were not followed, leading to potential unnecessary medication use.
A medication cart was left unlocked and unattended by an LVN during medication administration, posing a risk of unauthorized access and accidental ingestion by residents. Interviews with the RNS and DON confirmed the importance of securing the cart, as outlined in the facility's policy.
The facility failed to follow infection control protocols for two residents by not changing and labeling nasal cannulas as per policy. A resident's outdated nasal cannula was not replaced weekly, and another resident's nasal cannula and humidifier were not labeled upon admission, increasing infection risk.
The facility lacked a qualified Infection Preventionist (IP) with the necessary CDC-required training. The IPN held a 16-hour Boot Camp certificate, insufficient for the 19.75-hour requirement. The IPN and DON acknowledged the certification gap, and no policy outlined the required qualifications. The facility's job description mandated compliance with CDC and OSHA regulations, which was not achieved.
The facility failed to meet the required square footage per resident in 12 rooms, with some rooms housing two residents each measuring between 68.75 to 77.6 square feet per resident, and single-resident rooms not meeting the 100 square feet requirement. Despite this, observations showed residents had sufficient space for movement and care, with no adverse effects on privacy, health, or safety noted.
Failure to Provide Timely ADL Assistance and Call Light Response
Penalty
Summary
The deficiency involves the facility’s failure to provide timely assistance with activities of daily living (ADLs) and to respond promptly to call lights for three residents who required staff help. Surveyors observed a resident’s call light illuminated while an LVN, PT, and CNAs walked past the room without responding. Facility policy on call lights stated they were to be answered within a reasonable time, and the DON, LVN, and CNA interviewed all stated that all staff were responsible for answering call lights as soon as they were activated. One resident with diabetes, gait abnormalities, and coordination problems required substantial to maximal assistance with lower body dressing, toileting hygiene, transfers, and bed mobility, and was cognitively intact and able to communicate needs. This resident reported that on unspecified dates it sometimes took 30 minutes to one hour for night-shift nurses to respond to call lights for assistance with bathroom use and obtaining water. Another resident with diabetes, gait abnormalities, and a right below-knee amputation, who required supervision or touching assistance for ADLs and was frequently incontinent of urine and occasionally incontinent of bowel, stated that it sometimes took one hour for night-shift nurses to respond to call lights for incontinence care. A third resident with COPD, diabetes, gait abnormalities, and muscle weakness was totally dependent on staff for toileting, showering, and lower body dressing, was always incontinent of bowel and bladder, and was care planned for nursing assistance with toilet use. During observation and interview, this resident was seated in a chair with the call light on, stating a need to urinate. The ADM and CNA told the resident to urinate in the incontinence brief, and the resident reported that staff typically took about 30 minutes to respond to call lights, that she considered herself continent, that staff told her to urinate in her brief, and that she had not been provided a bedside commode and did not like being left wet while waiting to be changed. CNA and LVN interviews confirmed that telling the resident to urinate in the brief instead of offering a bedpan or bedside commode was not appropriate and that leaving residents wet or with unanswered call lights for extended periods was inconsistent with facility expectations and policies for perineal care and call light response.
Failure to Provide Timely Pain Management for Resident with Known Pain History
Penalty
Summary
A deficiency occurred when a resident with a history of cerebrovascular accident (CVA) and left side hemiplegia, who was known to experience acute and chronic pain, reported pain in her left arm and hand during care activities. The resident, who was severely cognitively impaired and dependent on staff for all activities of daily living, informed a CNA that her left hand was in pain after it became caught in the shower chair and again when it was stuck behind her during a mechanical lift transfer. Despite the resident's complaints, she was told to wait until after the shower, and her pain was not addressed at the time. The CNA stated she informed the LVN of the resident's pain, but the LVN reported being unaware of any pain complaints. Additionally, a restorative nursing assistant present during the transfer did not report the pain to anyone. The resident was not premedicated prior to care, despite her known history of pain and a care plan that called for administering pain medication before activities likely to cause discomfort. The facility's policy required prompt assessment and intervention for pain, but these steps were not followed, resulting in unmanaged pain for the resident.
Failure to Post Visitor PPE Instructions for C. Diff Positive Resident
Penalty
Summary
The facility failed to ensure that a contact precaution sign indicating the necessary personal protective equipment (PPE) for visitors was posted for a resident who tested positive for Clostridium difficile (C. Diff). This oversight was identified during an observation and interview with a Registered Nurse (RN) in front of the resident's room. Although a stop sign was present, instructing staff to follow contact isolation procedures and apply PPE, it did not provide instructions for visitors to wear PPE. The RN acknowledged the absence of visitor instructions and emphasized the importance of such signage to prevent the spread of C. Diff to other residents, visitors, and staff. The resident involved was admitted to the facility with diagnoses including orthopedic aftercare following surgical amputation and type 2 Diabetes Mellitus. The resident's lab results confirmed a positive test for C. Diff. The facility's policy and procedure documents, including the Infection Prevention and Control Program and Transmission-Based Precautions, as well as the Visitation policy, were reviewed. These documents indicated the facility's commitment to implementing infection control measures and establishing guidelines for visitors to prevent the transmission of communicable diseases. However, the lack of appropriate signage for visitors in this case represented a failure to adhere to these policies.
Facility Fails to Control Gnat Infestation
Penalty
Summary
The facility failed to maintain an effective pest control program, resulting in an infestation of gnats throughout the premises. Observations revealed gnats in various areas, including the residents' shared refrigerator, Resident 3's room, and the kitchen storage room. The shared refrigerator was found to contain numerous gnats, undated food containers, and a strong odor, indicating a lack of sanitation. Resident 3, who has cognitive impairments and requires assistance with daily activities, was observed swatting gnats away from her food, highlighting the potential for contamination. Interviews with staff and family members confirmed the presence of gnats during meal times, with reports of gnats emerging when food was present. The Dietary Manager and Maintenance Director acknowledged the issue, noting that the gnats were primarily originating from the kitchen drainage and bad fruits in the pantry. Despite efforts to clean and pour hot water down the drains, the infestation persisted. The Maintenance Director admitted that the facility's response was delayed, and pest control measures, such as fogging the kitchen, were not immediately implemented. The facility's pest control policy was not effectively enforced, as evidenced by the lack of UV fly traps in key areas and the improper maintenance of existing traps. The Director of Nursing and other staff members recognized the ongoing issue, with reports of gnats in residents' rooms and dining areas. The facility's failure to adhere to its policies on food storage and environmental sanitation contributed to the infestation, posing a risk of food contamination and discomfort for residents and staff.
Failure to Complete Accurate PASARR Assessments for Residents with Mental Illness
Penalty
Summary
The facility failed to ensure that three residents, who were diagnosed with mental illnesses prior to admission, had a Preadmission Screening and Resident Review (PASARR) assessment completed. This federal requirement is intended to prevent inappropriate placement in nursing homes and ensure residents receive necessary psychiatric services. The deficiency was identified during interviews and record reviews, revealing that the PASARR assessments for these residents were either inaccurately completed or not reviewed, potentially impacting their care and treatment. Resident 22 was admitted with diagnoses including major depressive disorder and psychosis, and was prescribed multiple psychotropic medications. However, the PASARR Level 1 assessment did not reflect these diagnoses or medications. The Director of Nursing (DON) acknowledged the inaccuracies and the potential impact on the resident's care. Similarly, Resident 24, with diagnoses of major depressive disorder, psychosis, and bipolar disorder, had a PASARR that incorrectly indicated no mental illness, which the DON admitted was documented incorrectly. Resident 13, diagnosed with psychosis and prescribed psychotropic medication, also had a PASARR that failed to indicate the diagnosis. The DON confirmed the PASARR was completed inaccurately, which could affect the resident's care. The facility's policy requires accurate PASARR screenings, but the deficiencies in these cases suggest a failure to adhere to this policy, potentially delaying necessary treatment and services for the residents involved.
Inaccurate MDS Documentation of Resident's Hearing Status
Penalty
Summary
The facility failed to ensure the accurate documentation of a resident's hearing status in the Minimum Data Set (MDS), a federally mandated resident assessment tool. The resident, who was admitted with diagnoses including anxiety and major depressive disorder, was documented in the MDS as having adequate hearing. However, the resident's care plan indicated a communication problem related to being hard of hearing in both ears, with interventions such as repeating messages aloud and using non-verbal communication cues. Interviews with the resident, a Certified Nurse Assistant (CNA), and a Registered Nurse Supervisor (RNS) confirmed that the resident was hard of hearing and would benefit from hearing aids. The Minimum Data Set Nurse (MDSN) acknowledged that the MDS inaccurately reflected the resident's hearing as adequate instead of minimal, which was necessary to ensure the resident received appropriate care and services. The Director of Nursing (DON) also confirmed that the MDS should have been marked as minimal for the resident's hearing. The MDS Nurse's job description emphasized the importance of accurate MDS completion and validation of medical record documentation to support MDS coding, highlighting the deficiency in this case.
Failure to Implement Anticoagulant Monitoring Care Plan
Penalty
Summary
The facility failed to implement care plan interventions for a resident receiving anti-coagulant therapy, specifically Eliquis, which is used to prevent or treat blood clots. The resident, who was admitted with diagnoses including venous thrombosis, embolism, and undergoing renal dialysis, had a care plan that required monitoring for signs and symptoms of bleeding, such as blood in urine, black tarry stools, and bruising. However, during interviews and record reviews, it was found that there was no documentation of monitoring for these symptoms, indicating that the care plan was not followed. Licensed Vocational Nurse (LVN) 3 and Registered Nurse Supervisor (RNS) 1 both acknowledged the lack of documentation and monitoring for bleeding, despite the resident's increased risk due to renal dialysis. The Director of Nursing (DON) also confirmed the importance of following the care plan to monitor for bleeding. The facility's policy on General Anticoagulation Management outlined the need for evaluation of bleeding, but this was not implemented for the resident, leading to a deficiency in care.
Failure to Assist Resident with ADLs
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs) to Resident 163, who was dependent on staff for showering and toileting hygiene. Resident 163, who had a displaced intertrochanteric fracture of the left femur and other medical conditions, required substantial assistance with mobility and dressing. On the day of the incident, Resident 163 requested a shower due to a wet diaper, but the Certified Nursing Assistant (CNA1) encountered difficulties transferring the resident to the shower chair because of the resident's inability to bend her left leg. CNA1, who was inexperienced in transferring Resident 163, returned the resident to bed with the help of another staff member and promised to provide a bed bath after lunch. However, CNA1 did not follow through with this promise, leaving Resident 163 feeling abandoned and neglected. The resident used the call light for assistance but did not receive the necessary care in a timely manner. CNA1 admitted to not seeking additional help or information on how to properly assist Resident 163, which contributed to the resident's unmet needs. Interviews with other staff members, including CNA2, LVN2, and the Director of Nursing (DON), revealed a lack of communication and coordination in addressing Resident 163's needs. The Physical Therapist (PT1) and RN Supervisor (RNS1) indicated that proper assistance and communication were necessary to prevent such incidents. The facility's policies on resident rights and ADL care emphasize the importance of timely and respectful care, which was not upheld in this case.
Failure to Conduct Timely Medical Test and Monitor Hematoma
Penalty
Summary
The facility failed to provide necessary care and services to Resident 32 by not ensuring a venous and arterial doppler test was conducted in a timely manner as ordered by the physician. The physician had ordered the test on 10/28/2024 to assess circulation in the resident's left leg due to pain and swelling. However, the test was not performed because the x-ray technician was unavailable, and there was no documentation indicating that the physician was notified of this delay. This lack of communication and follow-up could have led to a delay in diagnosis and treatment for the resident. Additionally, the facility did not adequately monitor and assess the size of a hematoma on Resident 32's left leg. The hematoma was first documented on 9/16/2024, and although it was visually checked, there was no accurate measurement to determine if it was increasing or decreasing in size. The resident had a history of a ruptured popliteal artery and was experiencing discomfort, yet the assessment of the hematoma was not specific, and the licensed nurse did not measure its size. The facility's policies and procedures require that the nurse supervisor notify the resident's attending physician when there is a significant change in the resident's condition or treatment. However, in this case, there was no documentation of such notification, and the resident was not informed of the delay in the medical test. This oversight in communication and assessment could have resulted in a delay in addressing potential complications related to the resident's condition.
Failure to Provide Hearing Services to Resident
Penalty
Summary
The facility failed to ensure that a resident, identified as Resident 12, received access to necessary hearing services. Resident 12 was admitted with diagnoses including anxiety and major depressive disorder. Despite the Minimum Data Set (MDS) indicating normal hearing, the resident's care plan noted a communication problem related to being hard of hearing in both ears. The care plan included interventions such as repeating messages aloud and using non-verbal communication methods. However, interviews with the resident and staff, including a CNA, a Registered Nurse Supervisor, and the Director of Nursing, confirmed that Resident 12 was hard of hearing and would benefit from hearing aids. The resident expressed a desire for hearing aids to improve her ability to hear, especially when watching television. The facility's policy on ancillary services stated that residents should be assessed for needs such as audiology services upon admission and reassessed quarterly or as needed. Despite this policy, the facility did not provide Resident 12 with access to hearing services, resulting in her continued difficulty in hearing. The staff acknowledged the resident's hearing issues and the potential benefits of hearing aids, yet no action was taken to address this need, leading to the deficiency noted in the report.
Inadequate Fall Risk Precaution for Resident
Penalty
Summary
The facility failed to provide appropriate safety precautions for a resident at risk for falls. Specifically, the resident, who had a history of transient ischemic attack, cardiac pacemaker, dementia, and anxiety, was on fall risk precaution with landing pads placed on the side of the bed. However, a bedside table was observed to be placed on top of the landing pads, which could potentially cause injury if the resident were to fall out of bed and hit their head on the table. Interviews with facility staff, including a CNA, LVN, RNS, and the DON, confirmed that the landing pads were intended to provide a cushioned landing to prevent injury in the event of a fall. The staff acknowledged that the placement of the bedside table on the landing pads was inappropriate and could pose a risk of injury to the resident. The facility's policy on falls indicated that interventions should be identified to prevent falls and address risks, but the presence of the bedside table on the landing pads was contrary to this protocol.
Deficiencies in Employee File Management and Competency Assessments
Penalty
Summary
The facility failed to ensure that employee files were reviewed and kept up to date, resulting in deficiencies in several key areas. Specifically, the facility did not conduct Tuberculosis (TB) tests upon hire and annually for several staff members, including the Director of Staff Development (DSD), Registered Nurse Supervisor (RNS) 1, Licensed Vocational Nurses (LVNs) 3, 4, and 5, and Certified Nurse Assistants (CNAs) 5 and 6. Additionally, these employees did not have a skills competency checklist at the time of hire and annually, nor did they receive annual performance evaluations. Health examinations were also not completed upon hire and annually, and background checks were not conducted prior to the hire date for these employees. During interviews, the DSD acknowledged the lack of TB tests, background checks, and annual competency skills assessments. The Director of Nursing (DON) confirmed that it was the DSD's responsibility to maintain up-to-date employee files to ensure staff competency and performance. The DON emphasized the importance of these records in maintaining resident care and safety, noting that the absence of annual health exams, including TB testing, could potentially expose residents and staff to TB. The facility's job descriptions for LVNs and RNs required evidence of being free of tuberculosis infection upon hire, which was not adhered to in these cases.
Failure to Monitor and Justify Medication Use
Penalty
Summary
The facility failed to ensure that two residents were free from unnecessary medications, leading to potential adverse effects. Resident 8 was prescribed methenamine for urinary tract infection prophylaxis without adequate monitoring or justification. The resident's records indicated no history of urinary tract infections, and no urinalysis or culture and sensitivity tests were conducted to confirm the need for the medication. Interviews with the Infection Preventionist Nurse and the Director of Nursing revealed that the prolonged use of methenamine could lead to antibiotic resistance and other adverse effects, such as diarrhea and the destruction of normal flora. Resident 32 was prescribed Eliquis for deep vein thrombosis prophylaxis, but the facility failed to monitor for potential adverse effects of the anticoagulant. The resident's care plan included monitoring for signs of bleeding and other complications, but there was no documentation of such monitoring in the Medication Administration Record. Interviews with nursing staff confirmed that the lack of monitoring placed the resident at risk for preventable conditions like bleeding and anemia. The facility's policies on medication regimen review and antibiotic stewardship were not followed, contributing to the deficiencies. The policies required that each resident's medication regimen be free from unnecessary drugs, with adequate monitoring and indications for use. The failure to adhere to these policies resulted in the inappropriate use of medications for both residents, highlighting a lapse in the facility's medication management practices.
Failure to Ensure Residents Are Free from Unnecessary Psychotropic Medications
Penalty
Summary
The facility failed to ensure that two residents were free from unnecessary psychotropic medications. For Resident 11, the facility did not provide non-pharmacological interventions before administering Ativan, a psychotropic medication, as needed for anxiety. Despite having a care plan that included non-pharmacological interventions, the Medication Administration Record (MAR) showed that these interventions were not documented or provided before administering the medication. Interviews with the Licensed Vocational Nurse (LVN) and the RN Supervisor confirmed that Ativan was given without documented episodes of anxiety, and non-pharmacological interventions were not attempted, which could lead to unnecessary medication use and potential side effects. Resident 22's case involved a failure to reevaluate the appropriateness of psychotropic medications. The resident was prescribed multiple psychotropic medications, including Abilify and Quetiapine Fumarate, for psychosis and depression. A Consultant Pharmacist's Medication Regimen Review recommended evaluating the use of these medications due to their similar actions, but this recommendation was not followed up. The Director of Nursing (DON) acknowledged that the psychiatrist referral was needed but not called, leading to a delay in evaluating the resident's condition and the appropriateness of the medications. This oversight could result in the use of unnecessary medications. The facility's policies and procedures on medication regimen review and psychotropic medications were not adhered to in these cases. The policies indicated that non-pharmacological interventions should be attempted before administering psychotropic drugs and that residents should not receive unnecessary medications. The failure to follow these policies resulted in the administration of psychotropic medications without proper assessment and documentation, placing the residents at risk for adverse effects.
Medication Cart Security Breach
Penalty
Summary
The facility failed to ensure that the medication cart was locked and secure during the administration of medications to residents. During an observation, a Licensed Vocational Nurse (LVN) left the medication cart unlocked and unattended while performing handwashing in another room and while entering a resident's room to administer medications. The LVN acknowledged the failure to lock the cart after preparing medications and before administering them to residents. Interviews with the Registered Nurse Supervisor (RNS) and the Director of Nursing (DON) confirmed that the medication cart should be locked when unattended to prevent unauthorized access and potential accidental ingestion of non-prescribed medicines by residents, particularly those with cognitive impairments. A review of the facility's policy and procedure on the security of the medication cart indicated that the cart must be locked before the nurse enters a resident's room or when out of the nurse's view.
Infection Control Deficiency in Nasal Cannula Management
Penalty
Summary
The facility failed to adhere to its infection control measures for two residents, leading to potential risks of infection. Resident 17, who was admitted with acute respiratory failure and atrial fibrillation, had a nasal cannula that was not changed according to the facility's policy. The nasal cannula was observed to be outdated, as it was dated 10/20/2024, despite the policy requiring a change every seven days. This oversight was confirmed by a Licensed Vocational Nurse (LVN), who acknowledged the importance of changing the nasal cannula to prevent infection. Similarly, Resident 168, admitted with a displaced intertrochanteric fracture and traumatic subdural hemorrhage, had a nasal cannula and humidifier that were not dated or labeled upon admission. This was contrary to the facility's policy, which mandates dating and labeling to ensure timely replacement. The Infection Prevention Nurse and the Director of Nursing both emphasized the necessity of changing the nasal cannula weekly to prevent infections, which could lead to serious health issues such as pneumonia.
Inadequate Infection Preventionist Certification
Penalty
Summary
The facility failed to have a qualified Infection Preventionist (IP) on staff with the necessary qualifications and specialized training in Infection Control and Prevention. During a record review, it was found that the Infection Prevention Nurse (IPN) held a 16-hour Boot Camp certificate for Long Term Care Facilities, dated 6/5/2018, which did not meet the required 19.75 hours of training as specified by the Centers for Disease Control and Prevention (CDC). In an interview, the IPN admitted to not having the correct certification and was unaware of the specific requirements. The Director of Nursing (DON) confirmed that the IPN did not possess the appropriate certification. Additionally, there was no policy or procedure in place regarding the required certification for the IP role. The facility's Infection Preventionist Job Description, dated 12/17/202, indicated the need for compliance with CDC, OSHA, and local regulations concerning infection control, which was not met.
Deficiency in Resident Room Size Requirements
Penalty
Summary
The facility failed to ensure that 12 resident rooms met the required square footage per resident, as mandated by regulations. Specifically, rooms 1, 2, 3, 5, 6, 7, 9, 12, 14, and 15, which housed two residents each, did not meet the 80 square feet per resident requirement, with measurements ranging from 68.75 to 77.6 square feet per resident. Additionally, rooms 4 and 17, which housed one resident each, did not meet the 100 square feet requirement, with room sizes of 149.5 and 155.25 square feet, respectively. This deficiency was identified through observations and a review of the Client Accommodations Analysis form provided by the facility's Maintenance Supervisor. Despite the deficiency in room size, observations conducted from October 29 to November 1, 2024, indicated that residents had sufficient space to move around freely, and nursing staff had adequate space to provide care. The rooms were equipped with necessary furniture and resident care equipment, and there were no adverse effects noted on the residents' privacy, health, or safety due to the room sizes. A Room Waiver letter dated October 19, 2023, indicated that no residents had complained about the available space, and there was no evidence suggesting that the room size variation adversely affected the residents' health and safety.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Lomita
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Palos Verdes Health Care Center | 1.1 mi | — | 24 | 0 |
| Sunnyside Nursing Center | 1.9 mi | — | 25 | 1 |
| Torrance Memorial Med Ctr Snf/dp | 1.9 mi | — | 3 | 0 |
| Vermont Healthcare Center | 2.2 mi | — | 29 | 1 |
| Beachside Post Acute | 2.4 mi | — | 10 | 0 |
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