Health inspection·February 2, 2024

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 20's admission into the facility, the staff were supposed to complete the inventory sheet and then bring him (SSD), the items Resident 20 came in with and he (SSD) would have done a check to ensure all items were accounted for. The SSD further stated he never received or was made aware of $2,200 dollars from Resident 20 and since it was such a large amount of money, he would have called Resident 20's family to see if they wanted to pick up the money. The SSD stated if family did not want to pick up the money, he would have placed the money in the safe and would have entered a progress note in the resident's medical record to indicate the amount of money the facility had in the safe for the resident. The SSD stated he was never notified by the staff who took the inventory (dated September 30, 2023) about the resident belongings and never put $2,200 dollars in the safe or called Resident 20's family to pick up any money. During an interview on February 1, 2024, at 10:45 AM, with LVN 2, LVN 2 stated she recalled her (LVN 2), and CNA 1 did the inventory list for Resident 20 on September 30, 2023, when the resident was admitted in the evening after hours. LVN 2 acknowledged the inventory list indicated the resident had $2,200 dollars. LVN 2 further stated she recalled there being a lot of money which she received from Resident 20. LVN 2 stated she placed the money in a Ziplock bag and locked it in the narcotic drawer (a drawer in the facility's medication cart which is locked and only accessible to authorized individuals who are able to administer controlled medications). LVN 2 then stated she endorsed the money to the charge nurse on the following shift. LVN 2 stated she put the money in the narcotics drawer because it was after hours, and the facility's usual process was to lock resident personal items in the narcotics drawer until it could be given to the SSD. During a concurrent observation and follow up interview on February 1, 2024, at 11:01 AM, with the SSD, the SSD stated if a resident was admitted to the facility after hours, the usual facility process was that staff would lock personal belongings in the narcotic drawer of the med cart and leave a progress note in the residents Electronic Health Record (EHR) so he (SSD) could follow up and retrieve the items. The SSD reviewed the EHR for Resident 20 and stated there was never a progress note entered indicating any items had been placed in a narcotics drawer. During an interview on February 1, 2024, at 11:17 AM, with LVN 3, LVN 3 stated she was the charge nurse on September 30, 2023, for the night shift and recalled receiving an endorsement from LVN 2 regarding Resident 20's money in the narcotic drawer. LVN 3 stated she recalled counting a large amount of money in the narcotics drawer, with LVN 2, and stated she then endorsed it to the charge nurse on the next shift. During an interview on February 1, 2024, at 11:31 AM, with Registered Nurse 1 (RN 1), RN 1 stated he was the RN supervisor on September 30, 2023, RN 1 further stated staff usually would inform him about such a large sum of money being placed in the narcotic drawer, but he was never notified. During an interview on February 1, 2024, at 11:33 AM, with CNA 1, CNA 1 stated she remembered receiving Resident 20 on September 30, 2023, and she recalled her (CNA 1) and LVN 2 counted $2,200 dollars and recorded it on Resident 20's inventory sheet. During an interview on February 1, 2024, at 1:45 PM, with the DON, the DON stated if something was ever removed from the facility's safe and given back to a resident, it would be documented in the residents Electronic Health Record (EHR). The DON reviewed Resident 20's EHR and stated there was no evidence Resident 20 was ever given $2,200 dollars back. During an interview on February 2, 2024, at 8:28 AM, with the DON, the DON stated she spoke to the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055001 If continuation sheet Page 2 of 11 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055001 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redlands Healthcare Center 1620 W Fern Ave Redlands, CA 92373 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0584 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few charge nurses who worked in the AM, at the facility on October 1, 2023. The DON further stated the nurses she spoke to recalled counting the $2,200 dollars in the narcotic drawer but after October 2, 2023, the money was unaccounted for, and nobody had information regarding where it went. During a review of the facility's policy and procedure titled, Personal Property, revised September 2012, the policy indicated, .5. The resident's personal belongings and clothing shall be inventoried and documented upon admission and as such items are replenished. During a review of the facility's policy and procedure titled, Investigating Incidents of Theft and/or Missapropriation of Resident Property, revised April 2017, the policy indicated, 1. Residents have the right to be free from theft and/or misappropriation of personal property .3. Our facility will exercise reasonable care to protect the resident from property loss or theft, including: .b. Providing measures to safeguard resident valuables . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055001 If continuation sheet Page 3 of 11 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055001 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redlands Healthcare Center 1620 W Fern Ave Redlands, CA 92373 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure one of one sampled residents (Resident 12) reviewed for dialysis (a procedure to remove waste products and excess fluid from the blood when the kidneys no longer function) was provided assessment and monitoring of Resident 12's left arm dialysis shunt (a surgical connection between a vein and an artery used to connect the patient to the dialysis machine) when: Residents Affected - Few 1. The facility did not assess Resident 12's shunt for warmth, color, and edema (swelling), in the frequency specified by the physician's orders. 2. The facility did not have documented evidence that a pre and post (before and after) dialysis assessment was done for the resident on November 1, 2023, and January 22, 2024, as specified by the facility's policy and procedure. These failures had the potential for a delay in the staff identification and subsequent treatment of possible dialysis associated complications such as infection, clotting, and excessive bleeding from the shunt. Findings: 1. A review of Resident 12's admission Record (contains medical and demographic information), indicated Resident 12 was initially admitted to the facility on [DATE], with diagnoses which included end stage renal disease (kidney failure), blindness in one eye, hemiplegia, and hemiparesis (weakness and paralysis) of the left side of the body, difficulty in walking, heart failure, and syncope (fainting) and collapse. During a concurrent observation and interview on January 31, 2024, at 9:08 AM, with Resident 12, Resident 12 had a gauze dressing (type of wound dressing) on his left arm. Resident 12 stated the gauze was covering his dialysis shunt and that he received dialysis every Monday, Wednesday, and Friday each week. During a review of Resident 12's physician's orders, dated March 19, 2022, indicated, Dialysis - Check (AV [arteriovenous] shunt .(Site) L [left] arm for Color, Warmth, & [and] Edema. Every shift. During a review of Resident 12's medical record, there was no documented evidence of staff checking the resident's shunt for color, warmth, and edema every shift as specified in the physician's orders. There was only documentation of assessment for color, warmth, and edema on the shift for which the resident went to dialysis three times a week (on Monday, Wednesday, and Fridays). During a concurrent interview and record review on February 1, 2024, at 8:17 AM, with the Director of Nursing (DON), the DON stated staff were supposed to follow physician's orders when completing assessments for residents who undergo dialysis. The DON further stated Resident 12's had a physician's order for staff to assess Resident 12's left arm for color, warmth, and edema every shift. The DON reviewed Resident 12's medical record and stated she was unable to find documented evidence that color, warmth, and edema was assessed for Resident 12 every shift, as ordered by the physician. The DON further stated there was only documentation of color, warmth, and edema on the shift Resident 12 went to dialysis on three of seven days every week. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055001 If continuation sheet Page 4 of 11 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055001 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redlands Healthcare Center 1620 W Fern Ave Redlands, CA 92373 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an interview on February 1, 2024, at 9:20 AM, with the Clinical Consultant (CC), the CC stated she reviewed Resident 12's medical record and was unable to find documented evidence staff assessed the resident for color, warmth, and edema every shift as specified by the doctor's orders. During a review of the facility's policy and procedure titled, End-Stage Renal Disease, Care of a Resident with, revised September 2010, the policy indicated, Residents with end-stage renal disease (ESRD) will be cared for according to currently recognized standards of care 2. Education and training of staff includes, specifically: .b. The type of assessment data that is to be gathered about the resident's condition on a daily or per shift basis . During a review of the facility's policy and procedure titled, Hemodialysis Access Care, revised September 2010, the policy indicated, .3. Care involves the primary goals of preventing infection and maintaining patency of the catheter (preventing clots). 4. To prevent infection and/or clotting: .d. Check for signs of infection (warmth, redness, tenderness, or edema) at the access site when performing routine care and at regular intervals . 2. During a concurrent interview and record review on February 1, 2024, at 8:17 AM, with the DON, the DON stated for each resident who underwent dialysis, staff was supposed to complete a document titled, Pre/Post Dialysis Assessment, undated, which included assessment of the resident before and after dialysis. The DON provided the document Pre/Post Dialysis Assessment, undated, which indicated, Access site bruit/thrill? Y/N [bruit/thrill - indicates good blood flow] .Sign of infection? Y/N .Bleeding after TX [treatment]? Y/N . The DON further stated the staff was also supposed to complete a form which was untitled, (undated). The untitled form was reviewed and indicated, Pre .Post dialysis assessment .Resident overall condition: lung sounds: B/P [blood pressure]: Temp [temperature]: Resp [respirations]; pulse [heart rate]: .Color: Warmth: Redness: Edema [swelling]: Drainage: Bleeding . During a review of Resident 12's Electronic Health Record (EHR), the Progress notes, dated November 1, 2023, and January 22, 2024, indicated the resident had dialysis on these dates. During a review of Resident 12's medical record on February 1, 2024, at 8:20 AM, there was no evidence that staff completed the Pre/Post Dialysis Assessment, form or any other dialysis assessment forms when Resident 12 went to dialysis on November 1, 2023, and January 22, 2024. During an interview on February 2, 2024, at 10:44 AM, with the DON, the DON stated the facility was unable to find documented evidence that staff completed a pre/post dialysis assessment for the resident on November 1, 2023, and January 22, 2024, when Resident 12 had dialysis. The DON further stated staff was supposed to complete the Pre/Post Dialysis Assessment form before and after dialysis as part of the assessment to ensure the resident was ok and had no complications from the procedure. During a review of the facility's policy and procedure titled, End-Stage Renal Disease, Care of a Resident with, revised September 2010, the policy indicated, Residents with end-stage renal disease (ESRD) will be cared for according to currently recognized standards of care 2. Education and training of staff includes, specifically: .b. The type of assessment data that is to be gathered about the resident's condition on a daily or per shift basis . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055001 If continuation sheet Page 5 of 11 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055001 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redlands Healthcare Center 1620 W Fern Ave Redlands, CA 92373 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure accurate medication storage and administration procedures were followed when: 1. Five (5) medication tablets were left unattended on Resident 62's bedside table. This failure had the potential for medications to be diverted and used inappropriately that may cause harm for Resident 62. 2. A Licensed Vocational Nurse (LVN 1) documented five (5) medications in the Medication Administration Record (MAR - a report detailing the medications administered to a resident) as given and were not administered to Resident 62. This failure had potential for erroneous or inconsistent medical care and medication administration that may cause harm and sub- therapeutic effect for Resident 62. Findings: 1. During an observation and interview on January 29, 2024, at 11:47 AM, Resident 62 was observed lying on bed. Resident 62 stated she was in the facility due to stroke. Five (5) different medication tablets (pills), [two (2) pink and three (3) white colored pills] were observed in a medicine cup sitting on the bed side table. When asked about the pills in cup, Resident 62 stated, The nurse left it for me this morning, I will take it with lunch. During a review of Resident 62's face sheet (patient demographics), the face sheet indicated, Resident 62 was admitted on [DATE], with diagnoses that included hemiplegia (paralysis of one side of the body) and hypertension (high blood pressure). During an interview with the LVN 1, on January 31, 2024, at 12:08 PM, when asked about the medications left on Resident 62's bedside table, LVN 1 stated someone must have called her and she forgot. During a review of the physician's order for Resident 62, it indicated following: a. Aspirin 81 mg (milligram-unit of measure) by mouth one time a day for stroke prevention with meals. Order dated November 17, 2023. b. Senna 8.6 mg, give 1 tablet by mouth two times a day for constipation. Order dated November 17, 2023. c. Multivitamin/Mineral tablet, give 1 tablet by mouth one time a day for supplement. Order dated November 22, 2023. d. Procardia XL (extended release) oral tablet 30 mg, give 1 tablet by mouth one time a day for hypertension (HTN), hold for sbp (systolic blood pressure) < (less than)100, heart rate (HR) < 60. Order dated November 17, 2023. e. Carvedilol oral tablet 25 mg give 1 tablet by mouth two times a day for HTN (hypertension), Hold for SBP <100, heart rate (HR) < 60, give with meals. Order dated November 17, 2023. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055001 If continuation sheet Page 6 of 11 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055001 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redlands Healthcare Center 1620 W Fern Ave Redlands, CA 92373 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a concurrent interview and record review on January 31, 2024, at 12:45 PM, with the DON, the PACS-MEDICATION ADMINISTRATION RECORD (MAR) for Resident 62, was reviewed. The DON stted all five (5) medications: Aspirin, Senna, Multivitamin/Mineral, Procardia, Carvedilol were documented as administered at 9:34 AM on January 29, 2024. During a further interview with the (DON) on February 1, 2024, at 3:05 PM, the DON stated, there was no physician order that Resident 62 can self-administer his own medication. The DON further stated, no medications should be left over the bed side table. If a resident was not able to take the medication, the nurse should return the medication back until the resident is ready to take it. 2. During a concurrent interview and record review on January 31, 2024, at 1:46 PM, with LVN 1, Resident 62's PACS-Medication Administration Record dated January 29, 2024, was reviewed. LVN 1 stated the following medications were documented as given at the following times: a. Aspirin oral tablet, 81 mg marked given at 9:34 AM. b. Senna 8.6 mg,1 tablet marked given at 9:34 AM. c. Multivitamin/Mineral tablet, 1 tablet marked given at 9:34 AM. d. Procardia XL oral tablet 30 mg marked given at 9:34 AM. e. Carvedilol oral tablet 25 mg marked given at 9:34 AM. When LVN 1 was asked if the above medications were the same medications left on Resident 62's bedside table on January 29, 2024, LVN 1 stated, Right, that was the same medications that I gave her, but she did not take them. During an interview and record review with the director of nursing (DON), on February 1, 2024, at 9:45 AM, the facility's policy and procedure Administering Medications, revised in April 2019, was reviewed. The policy indicated . 21. If a drug is withheld, refused, or given at a time other than the scheduled time, the individual administering the medication shall initial and circle the MAR space provided for that drug . 23. As required or indicated for a medication, the individual administering the medication records in the resident's medical record: . a. The date and time the medication was administered . The DON stated the licensed staff was aware of the policy. During a review of the facility policy and procedure titled, Medication Administration Schedule, revised in November 2020, indicated, . 3. Scheduled medications are administered within one hour (1) hour their prescribed time, unless otherwise specified . 7. The exact time of medication administration is documented in the MAR. If medication is administered early, late (beyond the allowable interval), or is omitted, the reason is also documented . During an interview, on February 1, 2024, at 3:05 PM, with the DON. The DON stated, licensed staff needs to document the administered medication after the resident takes the medications, before leaving the room. The DON further stated, regarding the medication on Monday (January 29, 2024), I talked to the resident. Yes, she (Resident 62) said the pills were left there for her. She (Resident 62) stated. I promised the nurse, I will take it, but I fell asleep. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055001 If continuation sheet Page 7 of 11 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055001 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redlands Healthcare Center 1620 W Fern Ave Redlands, CA 92373 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0803 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to follow the gluten free menu and meet nutritional needs for 3 residents ( Resident 11, 71, 45). This failure had the potential to affect the nutritional status of these already medically compromised residents. Findings: During an observation on January 29, 2024, at 11:50 AM, in the kitchen, the [NAME] was serving residents lunch and for Resident 11 and 71 the [NAME] served two bowls of 3 bean chili and did not serve the corn bread. During an interview on February 1, 2024, at 8:33 AM, with Cook, [NAME] stated, I did not make an alternative for gluten free diet on Monday, so I served an additional serving of the 3 bean chili for the residents on a regular gluten free diet and mashed potato with gravy for puree gluten free diet. During an interview on February 1, 2024, at 8:38 AM, in the dining room, with the Registered dietician (RD), RD stated, the expectation is to make a substitute for gluten free diet according to the recipe. During an interview on February 1, 2024, at 8:45 AM, in the dining room, with the Dietary Service Supervisor (DSS), DSS stated, the [NAME] should serve the gluten free diet according to the diet manual. During a review of resident 11's admission Record (patient demographic) indicated that Resident 11 was admitted on [DATE], with diagnoses [NAME] included unilateral primary osteoarthritis (joint inflammation with flexible tissue at the end of bones wear down) and encounter for palliative care (specialized medical care that provide relief from pain and other symptoms of a serious illness). During review of the Order Summary Report, for Resident 11, the summary report indicated, Dietary-Diet, order summary, indicted, Gluten free diet Pureed texture . During a review of Resident 71's admission Record, indicated that Resident 71 was admitted on [DATE], with the diagnoses that included acute kidney failure (when kidneys lose the filtering ability and waste will accumulate in blood), respiratory failure (a serious condition when one cannot breathe by own). During review of Order Summary Report, for Resident 71, the summary reported indicated, Dietary-Diet Order Summary, indicates, gluten free diet mechanical soft texture, thin liquids consistency . During a review of Resident 45's admission Record, indicated, that Resident 45 was admitted on [DATE], with the diagnoses that included malignant neoplasm of prostate (prostate cancer) and encounter for palliative care (specialized medical care that provide relief from pain and other symptoms of a serious illness). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055001 If continuation sheet Page 8 of 11 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055001 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redlands Healthcare Center 1620 W Fern Ave Redlands, CA 92373 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0803 Level of Harm - Minimal harm or potential for actual harm During a review of Order Summary Report, for Resident 45, Dietary-Diet Order Summary, indicated, Gluten free regular texture, thin liquids consistency . During a review of the facility's recipe titled, Recipe: Corn bread with [NAME] chilies, undated, the recipe indicated, Special diet: Gluten free: corn tortilla-1 with margarine . Residents Affected - Some During a review of facility's policy and procedure title, Menus, revised October 2017, indicated, Menus are developed and prepared to meet resident choices including religious, cultural, and ethnic needs while following established national guidelines for nutritional adequacy. During a review of facility's policy and procedure (P&P) titled, Therapeutic Diets, revised October 2017, the P&P indicated, Therapeutic diets are prescribed by the attending physician 1. Diet will be determined in accordance with the resident's informed choices, preferences, treatment goals and wishes .7. The dietician, nursing staff, and attending physician will regularly review the need for . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055001 If continuation sheet Page 9 of 11 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055001 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redlands Healthcare Center 1620 W Fern Ave Redlands, CA 92373 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation, interview, and record review the facility failed to ensure safe and sanitary food preparation and storage practices in the kitchen when: Residents Affected - Many 1. Crumbs were found on the bottom shelf of second reach-in freezer. This had the potential for microorganism growth to be inadvertently transferred to food. 2. Black greasy grime on the floor in the space between the stove and stainless steel counter. This had the potential for microorganism growth and to attract pests. 3. Four Bulk bin container, that were storing flour, sugar, thickener and oats, the lids were broken and were held together with masking tape. This had the potential to attract pests. Findings: 1. During a concurrent observation and interview on January 29, 2024, at 9:03 AM, in kitchen, with the Dietary Services Supervisor (DSS), crumbs were noted on the bottom shelf of second reach- in freezer, DSS stated, crumbs might be from the boxes in the freezer, but it should be kept clean. During an interview on February 1, 2024, at 8:38 AM, in the dining room, with the Registered Dietician (RD), RD stated, the expectation is to keep the reach in freezer as clean as possible. During a review of facility's policy and procedure titled, Sanitation,, undated, indicated, . All equipment shall be maintained as necessary and kept in working order . 9. All utensils, counter, shelves, and equipment shall be kept clean . During a review of the FDA Federal Food Code, (FDA) dated 2022, 4-601.11 indicated, Nonfood-CONTACT SURFACES of EQUIPMENT shall be kept free of an accumulation of dust, dirt, FOOD residue, and other debris. In addition, The objective of cleaning focuses on the need to remove organic matter from food-contact surfaces so that sanitization can occur and to remove soil from nonfood contact surfaces so that pathogenic microorganisms will not be allowed to accumulate, and insects and rodents will not be attracted. 2. During a concurrent observation and interview on January 29, 2024, at 9:30 AM, in kitchen, with the DSS, black greasy grime on the floor in the space between the stove and stainless-steel counter were noted, DSS stated, space should be cleaned, and aluminum foil should be changed daily. During an interview on February 1, 2024, at 8:38 AM, in dining room, with RD, the RD stated, the expectation is to keep the space between the stove and stainless-steel counter to be clean daily. During a review of facility's policy and procedure titled, Sanitation, undated, indicated, .9. All utensils, counter, shelves, and equipment shall be kept clean . (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055001 If continuation sheet Page 10 of 11 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055001 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/02/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redlands Healthcare Center 1620 W Fern Ave Redlands, CA 92373 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many During a review of the FDA Federal Food Code, dated 2022, 4-601.11 indicated, Nonfood-CONTACT SURFACES of EQUIPMENT shall be kept free of an accumulation of dust, dirt, FOOD residue, and other debris. In addition, The objective of cleaning focuses on the need to remove organic matter from food-contact surfaces so that sanitization can occur and to remove soil from nonfood contact surfaces so that pathogenic microorganisms will not be allowed to accumulate, and insects and rodents will not be attracted. 3. During a concurrent observation and interview on January 29, 2024, at 9:10 AM, in kitchen, with the DSS, four bulk storage bins, storing flour, sugar, thickener and oats, the lids were taped together to prevent from falling apart, DSS stated, the expectation is to keep close the lids without the tape. During an interview on February 1, 2024, at 8:38 AM, in dining room, with RD, RD stated, the expectation is that the lid should be covered completely on top of the bulk bin with no tape. During a review of facility's policy and procedure titled, Storage of food and supplies, undated, indicated, .6. Dry bulk foods (flour, sugar, dry beans, food thickener, spices, etc.) should be stored in seamless metal or plastic containers with tight covers, or in bins which are easily sanitized . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055001 If continuation sheet Page 11 of 11