Health inspection·July 3, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete indicated Resident 2 required maximal assistance for bathing, required moderate assistance for eating, oral hygiene, toileting hygiene, upper and lower body dressing, personal hygiene, and required supervision for chair/bed-to-chair transfer. The MDS indicated Resident 2 was occasionally incontinent (involuntary) for bladder (an organ that holds urine) and was frequently incontinent for bowel (part of the digestive system.During a review of Resident 2's CNA skin monitoring worksheet (a document in which a visual assessment of the resident's skin is performed when giving a shower) dated 2/15/2025, the CNA monitoring sheet indicated Resident 2 did not have any skin issues. During a review of Resident 2's CNA skin monitoring worksheet dated 2/19/2025, the CNA monitoring sheet indicated on 2/19/2025, there was a wound on the sacrococcyx (fused bone structure that consists of the sacrum [triangular bone at the base of the spine] and coccyx [tail bone]) area. Resident 2's CNA skin monitoring worksheet indicated the Treatment Nurse (TXN) was notified. During a review of Resident 2's Change of Condition (COC) dated 2/22/2025 at 3:09 p.m., the COC indicated Resident 2 had a stage 2 pressure injury, measuring 1.5cm x 1cm. During a concurrent interview and record review on 7/3/2025 at 11:36a.m. with Registered Nurse Supervisor 1 (RNS 1), RNS 1 stated the CNA skin monitoring worksheet dated 2/19/2025 indicated the TXN was notified Resident 2's sacrococcyx wound. RNS 1 stated a COC for Resident 2's skin change was done on 2/22/2025 (3 days later) but should have been done on 2/19/2025. During an interview on 7/3/2025 at 2:34p.m. with the Director of Nursing (DON), the DON stated that the COC is when there is a change of condition in a resident from normal to abnormal and a COC documentation would include the time of change, notification to the doctor, calling the family, and follow up documentation on the COC. The DON stated the staff must document the effectiveness of treatment or until the issue is resolved in the progress notes. The DON stated if there is no monitoring, the condition may get worse, and the interventions might not be effective if they are not following up, so they need to assess the resident every day and document every shift.During a review of the facility's policy and procedure (P&P) titled, [NAME] in Condition: Notification of dated 8/25/2021, the P&P indicated to ensure residents, family, legal representatives, and physicians are informed of changes in the resident's conditions. A facility must immediately inform the resident, consult with the resident's physician and/or NP, and notify, consistent with his/her authority, resident representative when there is: a significant change in the resident's physical, mental, or psychosocial status (that is, a deterioration in health, mental or psychosocial status in either life-threatening conditions or clinical complications).a need to alter treatment significantly (that is, a need to discontinue or change an existing form of treatment due to adverse consequences, or to commence a new form of treatment). Event ID: Facility ID: 055032 If continuation sheet Page 2 of 7 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 055032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Earlwood 20820 Earl Street Torrance, CA 90503 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one out of four sampled residents (Resident 2) received care to prevent pressure injuries (localized, pressure-related damage to the skin and/or underlying tissue usually over a bony prominence) to the sacrococcyx area.This deficient practice resulted in Resident 2 developing a stage II pressure injury on the sacrococcyx (fused bone structure that consists of the sacrum [triangular bone at the base of the spine] and coccyx [tail bone]) area and had the potential for risk of infection and pain. During a review of Resident 2's admission Record (Face Sheet), the admission Record indicated Resident 2 was admitted to the facility on [DATE] with diagnoses including encephalopathy (any damage or disease that affects the brain), dementia (group of thinking and social symptoms that interferes with daily functioning), and difficulty walking. During a review of Resident 2's history and physical (H&P) dated 2/14/2025, the H&P indicated Resident 2 had fluctuating capacity to understand and make decisions. During a review of Resident 2's minimum data set (MDS: a resident assessment tool) dated 5/28/2025, the MDS indicated Resident 2 was moderately impaired for making daily decisions. The MDS indicated Resident 2 required maximal assistance (provides more than half the effort) for bathing, required moderate assistance (provides less than half the effort) for eating, oral hygiene, toileting hygiene, upper (above waist) and lower (below waist) body dressing, personal hygiene, and required supervision for chair/bed-to-chair transfer. The MDS indicated Resident 2 was occasionally incontinent (involuntary) for bladder (an organ that holds urine) and was frequently incontinent for bowel (part of the digestive system). During a review of the Body Check dated 2/12/2025 at 12:39 p.m., the body check indicated Resident 2 did not have any skin issues. During a review of the Braden Scale (assessment tool used to predict a resident's risk of developing pressure injuries) dated 2/12/2025 at 12:41p.m., the Braden Scale indicated Resident 2 was at mild risk (score range 15-18) with a score of 17. During a review of Resident 2's CNA skin monitoring worksheet (a document in which a visual assessment of the resident's skin is performed when giving a shower) dated 2/15/2025, the CNA monitoring sheet indicated Resident 2 did not have any skin issues. During a review of Resident 2's CNA skin monitoring worksheet dated 2/19/2025, the CNA monitoring sheet on 2/19/2025 indicated there is a wound on the sacrococcyx area with documentation the Treatment Nurse (TXN) was notified. During a review of Resident 2's Change of Condition (COC) dated 2/22/2025 at 3:09 p.m., the COC indicated Resident 2 had a stage 2 pressure injury. The COC indicated Resident 2 was being changed by a Certified Nursing Assistant (CNA) 1 when CNA 1 noticed the wound on sacrococcyx. measuring 1.5cm x 1cm. During a review of Resident 2's care plan (CP) untitled initiated 2/23/2025, the CP indicated Resident 2 has a stage 2 pressure injury measuring 1.5centimeter (cm: unit of length) by (x) 1cm. During an interview on 7/1/2025 at 3:25p.m. with Resident 2's Family Member 2 (FM 2), FM 1 stated Resident 2 got a bed sore at the facility and indicated the day prior to getting transferred to the General Acute Care Hospital (GACH) on 2/26/2025, the staff had left Resident 2 in her feces for a long time, and it was all over the bed. FM 2 stated the staff would not get Resident 2 up out of bed on a regular basis and would only get out of bed for 30 to 45 minutes with Physical Therapy (PT: diagnose and treat individuals to improve movement). FM 2 stated Resident 2 did not walk, had a diaper that was not changed on a regular basis, and the staff would state they are short-staffed when asked for assistance. During a concurrent interview and record review on 7/2/2025 at 4:00p.m. with the TXN, the TXN stated Resident 2's stage 2 pressure injury would be considered acquired in the and indicated if a resident is lying on their back and not turning much, or due to immobility, the resident can develop a pressure injury. The TXN stated Resident 2 was being changed by a CNA and has a Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055032 If continuation sheet Page 3 of 7 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 055032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Earlwood 20820 Earl Street Torrance, CA 90503 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete stage 2 measurement of 1.5cm x 1cm. The TXN stated, in two hours, a stage I can develop to a stage 2 if the resident is not cleaned or turned. During an interview on 7/3/2025 at 10:02 a.m. with Licensed Vocational Nurse 1 (LVN 1), LVN 1 stated if a resident is not being repositioned or if they sit in urine/feces for too long, it can cause the skin to breakdown. LVN 1 stated this can create pressure injuries to the skin and can become painful. During a concurrent interview and record review on 7/3/2025 at 11:36 a.m. with Registered Nurse Supervisor 1 (RNS 1), RNS 1 stated Resident 2 was incontinent for both bowel and bladder. RNS 1 stated Resident 2's Braden Score dated 2/24/2025 indicated Resident 2 was at moderate risk (score of 13-14) with a score of 13. RNS 1 stated the CNA skin monitoring worksheet dated 2/19/2025 indicated the TXN was notified of Resident 2's skin changes on the sacrococcyx and the COC for Resident 2's skin change was done on 2/22/2025 (3 days later). RNS 1 stated the COC should have been done on the same day, 2/19/2025. RNS 1 stated Resident 2's stage II pressure injury could have been preventable. During a concurrent interview and record review on 7/3/2025 at 2:24p.m., with the Director of Nursing (DON), the DON stated pressure injuries are preventable by turning and repositioning, cleaning the residents, providing good nutrition, and providing a low air mattress. During a review of the facility's policy and procedure (P&P) titled, Skin Integrity Management dated 5/26/2021, the P&P indicated the purpose is to provide safe and effective care to prevent the occurrence of pressure ulcers, manage treatment, and promote healing of all wounds. The implementation of an individual patient's skin integrity management occurs within the care delivery process. Identify patient's skin integrity status and need for prevention intervention or treatment modalities through review of all appropriate assessment information. During a review of the facility's P&P titled, Wound Prevention, undated, the P&P indicated the purpose of this program is to assist the facility in the care, services and documentation related to the occurrence, treatment, and prevention of pressure as well as non-pressure related wounds. All residents will have the following nursing care procedures implemented: as tolerated by the resident encourage ambulation and out of bed activity, as tolerated by the resident encourage mobility, as needed position and reposition the resident with pillows and other supportive devices, when the resident requires incontinence brief, check for moisture frequently and apply house stock barrier cream after each incontinent episode. Event ID: Facility ID: 055032 If continuation sheet Page 4 of 7 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 055032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Earlwood 20820 Earl Street Torrance, CA 90503 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 0880 Provide and implement an infection prevention and control program. 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 implement infection control measures for one of two sample residents (Resident 1) by failing to: 1. Ensure proper Personal Protective Equipment (PPE: equipment worn (gown, gloves, goggles) to help create a barrier between a healthcare worker and germs) was worn for Resident 1 that was on Enhanced Barrier Precaution (EBP: infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDROs).2. Ensure proper hand hygiene was performed during glove changes.3. Ensure Resident 1's indwelling catheter (or known as Foley catheter, a tube that allows urine to drain from the bladder into a bag that is usually attached to the thigh) drainage bag was not touching the floor.4. Ensure the rooms were deep cleaned after medication to treat Scabies (a contagious skin condition caused by tiny insects called mites that infest and irritate skin causing intense itching, inflammation, and red patches) were applied. These deficient practices had the potential to transmit infectious microorganisms and increase the spread of infection to all residents and staff in the facilityDuring a review of Resident 1's admission Record (Face Sheet), the admission Record indicated Resident 1 was initially admitted on [DATE] and was readmitted on [DATE] with diagnoses including metabolic encephalopathy (any damage or disease that affects the brain by underlying medical condition [diabetes: a disorder characterized by difficulty in blood sugar control and poor wound healing]), infection and inflammation reaction due to indwelling urethral catheter, and functional quadriplegia (complete inability to move due to severe disability or frailty). During a review of Resident 1's history and physical (H&P) dated 2/10/2025, the H&P indicated Resident 1 had fluctuating capacity to understand and make decisions as Resident 1 had dementia (a progressive state of decline in mental abilities).During a review of Resident 1's minimum data set (MDS: a resident assessment tool) dated 5/28/2025, the MDS indicated Resident 1 was cognitively mildly impaired. The MDS indicated Resident 1 was dependent on chair/bed-to-chair transfer, toileting hygiene, bathing, lower body (below waist) dressing, required maximal assistance (provides more than half the effort) for lying to sitting on side of bed, required moderate assistance (provides less than half the effort) for personal hygiene, upper body (above waist) dressing, and required supervision for eating and oral hygiene. During a review of Resident 1's Change of Condition (COC) dated 5/2/2025 at 2:30p.m., the COC indicated Resident 1 had a rash all over body. The COC indicated Resident 1 had a rash with persistent mild to moderate itching unrelieved by topical treatment or mild antihistamines (medication to alleviate symptoms such as itching). The COC indicated the recommendation for Resident 1 was Permethrin (a medication applied to the entire body to treat scabies) 5% cream. During a review of Resident 1's lab result report 5/2/2025 at 3:32p.m., the lab report indicated Resident 1 tested positive for scabies. During a record review of Resident 1's Medication Administration Record (MAR: electronic medication administration document) dated 5/1/2025 - 5/31/2025, the MAR indicated Resident 1 had an order for Permethrin External Cream with a start date of 5/3/2025. During a record review of Resident 1's Treat Administration Record (TAR: electronic treatment administration document) dated 5/1/2025 5/31/2025, the TAR indicated Resident 1 was treated with Permethrin External Cream with a start date of 5/23/2025 and discontinued on 5/25/2025. During a record review of Resident 1's TAR dated 6/1/2025 6/3/2025, the TAR indicated Resident 1 was treated with Permethrin External Cream with a start date of 5/26/2025 and discontinued 6/2/2025.During a record review of Resident 1's TAR dated 6/1/2025 6/30/2025, the TAR indicated Resident 1 was treated with Permethrin External Cream with a start date of 6/18/2025 every Wed and Sat for itching until 6/25/2025 and must shower resident the next day. During a review of Quality Control Inspection (QCI)-Housekeeping, the QCI indicated Resident Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055032 If continuation sheet Page 5 of 7 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 055032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Earlwood 20820 Earl Street Torrance, CA 90503 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 1's room was deep cleaned on the following days:-5/1/2025-5/14/2025-5/28/2025-6/7/2025-6/12/2025-6/15/2025-6/25/2025During an interview on 7/1/2025 at 2:35p.m. with Family Member 1 (FM 1), FM 1 stated Resident 1 had scabies, the staff never wore PPE protection during care and indicated the facility has placed Resident 1 back onto dirty sheets after a shower.During a concurrent observation and interview on 7/1/2025 at 4:01p.m. with Licensed Vocational Nurse 2 (LVN 2), LVN 2 stated Resident 1 is on EBP precautions because she has an indwelling catheter. LVN 2 was observed wearing gloves without prior hand hygiene and taking the blood pressure cuff off Resident 1's right arm without an isolation gown. No hand hygiene was observed after LVN 2 removed her gloves and proceeded to pour water into a cup and opened a straw paper for Resident 1. LVN 2 was observed going back into Resident 1's room, without an isolation gown while administering medication, touched Resident 1's forehead and left cheek with her right hand, and gave Resident 1 water for the medications. LVN 2 stated isolation gowns are worn when they have close contact with residents, move or turn the residents and when they are administering medications. LVN 2 stated when she touched Resident 1's forehead and cheek, she did not have to wear a gown because she was wearing gloves. LVN 2 stated direct contact means when you are touching the resident skin and indicated she was supposed to wear a gown when she touched Resident 1's forehead and cheek to protect herself and the resident. LVN 2 stated hand hygiene is performed prior to entering and leaving the residents room and when gloves are removed. LVN 2 stated hand hygiene is done for cleanliness. During a concurrent observation and interview on 7/1/2025 at 4:22p.m. with the Infection Preventionist (IPN), Resident 1's indwelling catheter was observed touching the floor. The IPN stated the foley catheter should not be touching the floor due to infection control practices. The IPN stated Resident 1 is on EBP due to the foley catheter, and when you are having direct contact with the residents, such as touching their face, you must wear a gown to protect the resident and yourself from infection. The IPN stated hand hygiene is performed in between tasks, prior to entering residents' rooms and exiting residents' rooms to prevent any transmission of bacteria. During an interview on 7/2/2025 at 12:08p.m. with the IPN, the IPN stated prior to Resident 1 going back to the room, everything must be disinfected to prevent the resident from getting scabies again after each shower. During a concurrent interview and record review on 7/3/2025 at 1:59p.m. with the Maintenance Supervisor (MS), the MS stated every day that two rooms are chosen to deep clean and indicated deep cleaning includes cleaning the curtains, disinfecting the bed, and cleaning the whole bedroom. The MS stated based on the Quality Control Inspection ([QCI]-Housekeeping document), Resident 1's room was cleaned on 6/12/2025, 6/15/2025, 6/19/2025, 6/22/2025, and 6/25/2025. The MS stated Resident 1's room was also deep cleaned on 5/14/2025, but it was not until June 2025 that he started cleaning Resident 1's room constantly due to FM 1's concerns regarding linen. The MS stated as soon as he is told a resident has scabies, they would deep clean the room as they do not want it to spread but is not sure how often the rooms have to be deep cleaned if a resident tested positive for scabies. The MS stated he had not started a shower log and does not have any documents to indicate when the showers were deep cleaned. The MS stated showers are usually cleaned 3 times a week. During a concurrent observation and interview on 7/3/2025 at 2:24p.m. with the Director of Nursing (DON), the DON stated EBPs indicated the resident is on isolation, and PPE equipment is worn to protect the residents and staff. The DON stated if there is no direct contact with the resident, a gown is not needed, however per observation of LVN 2 giving medication to Resident 1 without a gown, who has an indwelling catheter; the DON indicated LVN 2 needed to wear a gown. The DON stated hand hygiene is performed before and after taking care of a resident, when encountering a resident, and in between glove changes. The DON stated hand hygiene is performed to prevent transmitting bacteria to others and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055032 If continuation sheet Page 6 of 7 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 055032 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Earlwood 20820 Earl Street Torrance, CA 90503 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete yourself. The DON stated foley catheters should not touch the floor to prevent any infection. The DON stated Resident 1 was confirmed with scabies and indicated after the permethrin treatment, they would have to deep clean Resident 1's room as there may be more bugs in the room. During a review of the facility's policy and procedure (P&P) titled, Handwashing/Hand Hygiene dated 9/18/2023, the P&P indicated this facility considers hand hygiene the primary means to prevent the spread of infections. All personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections and other personnel, residents, and visitors. Use an alcohol-based hand rub containing at least 62% alcohol after contact with blood, body fluids, visibly contaminated surface or after contact with objects in the resident room.after removing personal protective equipment. The use of gloves does not replace hand washing/hand hygiene. Integration of glove along with routine hand hygiene is recognized as the best practice for preventing healthcare-associated infections. During a review of the facility's P&P titled, Polices and Procedures-Infection Prevention and Control revised date 12/2023, the P&P indicated the facility adopted infection prevention and control policies and procedures are intended to help maintain a safe, sanitary, and comfortable environment and to help prevent and manage transmission of diseases and infections. Infection prevention and control policies and procedures apply to all personnel, consultants, contractors, residents, visitors, and volunteers. The objectives of the infection prevention and control policies and procedures are to: a. monitor, prevent, detect, investigate, and control infections in the facility;b. maintain a safe, sanitary, and comfortable environment for personnel, residents, visitors, and the general public; and c. provide evidence-based guidelines for infection prevention and control based on current best practices. During a review of the facility's P&P titled, Enhanced Standard/Barrier Precautions revised date 2/21/2025, the P&P indicated it is the policy of this facility to implement enhanced barrier precautions for the prevention of transmission of multidrug-resistant organisms. Enhanced barrier precautions (EBP) refer to an infection control intervention designed to reduce transmission of multidrug-resistant organisms that employs targeted gown, and gloves use during high contact resident care activities. PPE for enhanced barrier precautions is only necessary when performing high-contact care activities. Event ID: Facility ID: 055032 If continuation sheet Page 7 of 7