Fountain View Subacute And Nursing Center
5310 Fountain Ave., Los Angeles, CA 90029
Citation Number: 920008483
Citation Date: 12/21/2011
Violation Date: 9/6/2010
Class: AA
Penalty: $ 75,000

On 9/6/2010, an 89 year old resident suffered a severe fatal brain injury from a fall that occurred a day after he was admitted to Fountain View Subacute. At the time of the fall, the resident was recovering from an earlier fall and was considered a very high risk for falls. He was found on the floor at 1 am with a bump on his head, which a family member described as the size of a goose egg. The facility had not taken necessary protective steps to prevent falls. His doctor ordered the facility to monitor his neurological status after the fall but records indicated it did not do so. Hours after the fall, the resident lost consciousness, was transferred to an acute care hospital, diagnosed as having suffered a large subdural hematoma, and placed on life support in the intensive care unit. He died three days later due to blunt head trauma. The facility was cited because its failure to provide adequate supervision and necessary care led to the resident's severe brain injury and death.