Health inspection·January 6, 2026

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident 2's Order Summary Report, dated 1/15/2025, the Report indicated Resident 2 required enhanced EBP due to the presence of Resident 2's suprapubic catheter (a thin tube draining urine from the bladder through a small opening in the lower abdomen).During a review of Resident 2's H&P, dated 8/12/2025, the H&P indicated Resident 2 had the capacity to understand and make decisions.During a review of Resident 2's MDS, dated [DATE], the MDS indicated Resident 2 had no cognitive impairment, had an indwelling catheter, and was dependent on staff for eating, oral hygiene, personal hygiene, and rolling left and right (in bed).During a review of Resident 2's Bowel and Bladder Evaluation, dated 12/23/2025, the Evaluation indicated Resident 2 had a suprapubic catheter. During an observation on 1/6/2026 at 8:43 a.m., in Resident 2's room, CNA 4 was observed not wearing a gown while feeding Resident 2 breakfast.3. During a review of Resident 3's admission Record, the admission Record indicated Resident 3 was admitted to the facility on [DATE] and readmitted on [DATE]. The admission Record indicated Resident 3 had diagnoses including colostomy (a surgical procedure that brings one end of the large intestine out through the abdominal wall to allow waste to leave the body), cellulitis (a skin infection that causes swelling and redness), and diabetes mellitus (DM- a disorder characterized by difficulty in blood sugar control and poor wound healing).During a review of Resident 3's H&P, dated 10/1/2025, the H&P indicated Resident 3 had fluctuating capacity to understand and make decisions.During a review of Resident 3's MDS, dated [DATE], the MDS indicated Resident 3 had severely cognitive impairment. The MDS indicated Resident 3 had an ostomy, required touching assistance (helper provides verbal cues and/or touching) to eat and was dependent on staff for toilet hygiene and showering.During a review of Resident 3's Bowel and Bladder Evaluation, dated 1/6/2026, the evaluation indicated Resident 3 had a colostomy.During a review of Resident 3's Order Summary Report, dated 1/6/2026, the Report indicated Resident 3 required EBP due to his colostomy.During an observation on 1/6/2026 at 8:18 a.m., in Resident 3's room, CNA 1 and CNA 3 were observed not wearing a gown and gloves when they moved and repositioned Resident 3. CNA 1 and CNA 3's uniforms and hands touched Resident 3 and his linens.During a concurrent observation, interview and record review on 1/6/2026 at 8:22 a.m., in Resident 3's room, CNA 3 was observed not wearing a gown and gloves while feeding Resident 3. The EBP Informational Sign, dated 9/9/2024, was reviewed. CNA 3 stated staff were required to wear a gown and gloves for all high-contact activities with Resident 3, which included feeding and repositioning the resident, to prevent infection transmission.During a concurrent interview and record review on 1/6/2026 at 8:58 a.m., with Licensed Vocational Nurse (LVN) 1, the EBP Information Sign, dated 9/9/2024, was reviewed. LVN 1 stated staff should wear gowns and gloves any time high-contact resident care activities occur, including feeding, turning, and repositioning Residents 1, 2, and 3. LVN 1 stated Residents 1, 2, and 3 were at higher risk of infection when staff did not wear gowns and gloves during high-contact care.During a concurrent interview and record review on 1/9/2026 at 2:22 p.m., with the Director of Nursing (DON), the facility's P&P titled, Enhanced Barrier Precautions, dated 6/29/2022, the facility's Enhanced Barrier Precaution Informational Sign, dated 9/9/2024, Resident 1's care plan titled Resident at risk for MDRO colonization., dated 12/3/2024, Resident 2's care plan titled Resident at risk for MDRO colonization., dated 12/3/2024, and Resident 3's Order Summary Report, dated 1/6/2026, were reviewed. The DON stated high-contact resident care activities included feeding, and mobility assistance such as turning and repositioning, due to staff's close proximity to the residents. The DON stated staff should have been wearing a gown and gloves while feeding, repositioning, and turning Residents 1, 2, and 3.During a review of the facility's P&P titled, Enhanced Barrier Precautions, dated 6/29/2022, the P&P indicated EBP is an infection control intervention to reduce transmission of resistant organisms that employs targeted gown and glove use during high (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055052 If continuation sheet Page 2 of 3 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 055052 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/06/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE California Post-Acute Care 3615 E. Imperial Hiwy Lynwood, CA 90262 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 contact resident care activities. EBP is indicated for residents with indwelling medical devices (e.g. feeding tube, urinary catheter) or wounds. The P&P indicated gowns and gloves are required prior to high-contact care activities. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055052 If continuation sheet Page 3 of 3