Health inspection·December 30, 2025

F 0558 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete called and she couldn't answer the call light right away.During a concurrent observation and interview with Licensed Vocational Nurse 2 (LVN 2) on 12/30/2025 at 1:29 p.m., LVN 2 were observed sitting on Nursing Station 1. LVN 2 stated, she heard the buzzing sound while she was sitting in the nursing station, LVN 2 stated, I don't work here, I'm from the registry.During an interview with Licensed Vocational Nurse 1 (LVN 1) on 12/30/2025 at 1:30 p.m., LVN 1 was observed sitting on Nursing Station 1 and was working on a computer. LVN 1 stated, there are buzzing sound and call lights on for two rooms. LVN 1 stated, she is going through paperwork for new admissions and new orders today. LVN 1 further stated, I can use the overhead page system for staff to respond on call lights request.During an interview with Registered Nurse 1 (RN 1) on 12/30/2025 at 2:20 p.m., RN 1 stated, the call lights should be answered immediately, and any staff can answer the call light, and if the call lights were not attended right away, resident may be in harm. RN 1 further stated, all staff is responsible for answering call light, even if they are under registry, and even if they are working on something currently, they are able to use the overheard page to ask for help from staff who are working on the floor.During a review of the facility's policy and procedures titled, Call Lights: Accessibility and Timely Response, reviewed on 1/2025, the P&P indicated that, Staff members who see or hear an activated call light are responsible for promptly responding. If staff member cannot provide what Resident desires, appropriate personnel should be notified.During a review of the facility's P&P titled, Quality of Life - Accommodation of Needs, revised on 1/2025, the P&P indicated that, The resident's individual needs and preferences shall be accommodated to the extent possible, except when the health and safety of the individual or other residents would be endangered. Event ID: Facility ID: 055155 If continuation sheet Page 2 of 4 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 055155 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ocean Pointe Healthcare Center 1330 17th Street Santa Monica, CA 90404 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 ensure that staff follow infection prevention when Treatment Nurse 1 (TXN 1) and Certified Nurse Assistant (CNA) 3 did not wear personal protective equipment (PPE- protective items or garments worn which includes the use of gloves, gown, mask, face shield, when anticipating coming in contact with blood, body fluids or other communicable toxins or agents) when providing suprapubic catheter change for one of four sampled residents (Resident 1) who was on Enhanced Barrier Precaution (an infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDROs - bacteria that are resistant to more than one antibiotic and can cause serious infections in nursing facilities).This deficient practice has a potential for Resident 1 risk for acquiring and transmitting infection to other residents, staff and visitors in the facility.Findings:During a review of Resident 1's admission Record , the admission record indicated Resident 1 was admitted to the facility on [DATE] with diagnosis including hypertension (HTN-high blood pressure), type 2 diabetes mellitus (a disorder characterized by difficulty in blood sugar control and poor wound healing), Alzheimer's Disease (a disease characterized by a progressive decline in mental abilities) and obstructive uropathy (a condition in which the flow of urine is blocked and urine flows backward from your bladder into your kidneys).During a review of the Minimum Data Set (MDS - resident assessment tool) dated 12/2/2025, indicated Resident 1's cognitive (mental action or process of acquiring knowledge and understanding) skills suggests that the individual has a severe level of cognitive impairment. The MDS indicated Resident 1 requires moderate to maximum assistance from the staff for activities of daily living (ADLs- routine tasks/activities such as bathing, dressing and toileting a person performs daily to care for themselves). The MDS also indicated that Resident 1 had a suprapubic catheter. During a review of Resident 1's Order summary report dated 12/31/2025, the order summary indicated a physician's order was initiated on 08/05/2025 stated Enhanced Barrier Precaution (EBP) related to suprapubic catheter- Apply enhanced barrier to prevent the spread of infections for specific care activities such as: morning and evening care, toileting and changing incontinence briefs, caring for devices and giving medical treatments, wound care, mobility assistance and preparing to leave the room, cleaning and disinfecting the environment every shift for monitoring.During an observation on 12/30/2025 at 10:46 a.m., a signage of Enhanced Barrier Precaution was posted outside of Resident 1's room. Treatment Nurse 1 (TXN 1) was observed changing Resident 1's suprapubic catheter with Certified Nursing Assistant 3 (CNA 3) at Resident 1's bedside. Neither TXN 1 and CNA 3 wore complete PPE. During an interview with TXN 1 on 12/30/2025 at 12:02 p.m., TXN 1 stated that he forgot to observe the EBP while changing Resident 1's suprapubic catheter change. TXN 1 stated that CNA 3 should have worn PPE while assisting. TXN 1 explained the facility follows EBP protocol to reduce the risk of spreading multidrug-resistant organisms (MDROs). TXN 1 acknowledged that failing to follow EBP could result in staff transmitting bacteria or viruses to other residents. During an interview with Infection Preventionist (IP 1) on 12/30/2025 at 1:27 p.m., IP 1 stated that residents that have suprapubic catheter are placed on EBP. IP 1 added that staff are expected to wash hands and wear proper PPE. IP 1 further stated that if EBP is not followed, there is a high risk of transmitting bacteria to another resident if staff are not wearing proper PPE. During a review of the facility's P&P titled, Suprapubic Catheter Care, revised on 01/2025 indicated the P&P indicated that equipment and supplies listed for suprapubic catheter care procedure included wash basin; soap and water; washcloth; towel; bed protector; drainage sponge (if ordered by physician); and Personal protective equipment (e.g., gowns, gloves, mask, etc., as needed).During a review of the facility's P&P titled, Enhanced Barrier Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055155 If continuation sheet Page 3 of 4 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 055155 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/30/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Ocean Pointe Healthcare Center 1330 17th Street Santa Monica, CA 90404 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Precautions, reviewed on 01/2025, the P&P indicated that, Facility staff shall perform hand hygiene and will don gown and gloves before performing the following high-contact resident care activities: (may not need to don gowns and gloves prior to entering the resident's room) dressing; bathing/showering; transferring; providing hygiene; changing linens; changing briefs or assisting with toileting; device care or use: central line, urinary catheter, feeding tube, tracheostomy/ventilator and wound care on chronic wounds requiring a dressing. Event ID: Facility ID: 055155 If continuation sheet Page 4 of 4