Health inspection·January 5, 2024

F 0558 During a record review of the facility's Policy and Procedure (P&P) titled, Call Light, reviewed in 2/2023, the P&P indicated, place the call device within resident's reach before leaving room. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 2 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure to provide information regarding Advance Directives (AD, legal document that provide instructions for medical care which go into effect when a person becomes disabled) to two of two sampled residents (Resident 82 and 47). This deficient practice had the potential for facility staff to provide care and treatment against the resident's will. Findings: a. During a review of Resident 82's admission Record, the admission record indicated Resident 82 was admitted on [DATE], with diagnoses that included dysphagia (difficulty swallowing) and hemiplegia and hemiparesis (hemiplegia is paralysis of partial or total body function on one side of the body, hemiparesis is onesided weakness, but without complete paralysis). During a review of Resident 82's Minimum Data Set (MDS, a resident assessment and care screening tool) dated 12/8/2023, the MDS indicated Resident 82 had clear speech, sometimes understood others, and sometimes made self-understood. The MDS indicated Resident 82 was dependent (helper does all of the effort) on personal hygiene, eating, oral hygiene and toileting. During a review of Resident 82's Advance Directive Acknowledgment form, dated 12/6/2023, the form was not completed/signed. During a concurrent interview and record review on 1/3/2024 at 2:30 pm, Social Service Director (SSD) stated she did not obtain a signature from Resident 82's responsible party to complete Resident 32's AD Acknowledge Form. The SSD stated Resident 82's AD Acknowledgment Form needed to be completed upon admission to determine the resident's treatment choices and preferences. The SSD stated the AD would guide the facility staff to provide medical treatment based on the resident's wishes during an emergency. The SSD stated, AD was a resident's right. During a review of the facility's Policy and Procedure (P&P) titled, Advance Directives and Associated Documentation, revised 2/1/2023, the P&P indicated, Prior to, upon, or immediately after admission, a facility staff member shall: provide the resident/family or responsible agent written information regarding the right to accept or refuse medical treatment and the right to formulate Advance Directives. Document in the resident health record that, at the time of admission, the resident/family had been provided with written information regarding advance directives.b. During a review of Resident 47's admission Record, the admission record indicated the facility admitted the resident on 6/20/2020, with diagnoses that included epilepsy (a brain disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, associated with abnormal activity in the brain,) and chronic obstructive pulmonary disease (COPD - chronic inflammatory lung disease that causes obstructed airflow from the lungs.) During a review of Resident 47's MDS dated [DATE], the MDS indicated the resident usually understands verbal content and usually able to express ideas and wants. The MDS indicated Resident 47 required extensive assistance (resident involved in activity, staff provide weight-bearing support) with bed mobility, dressing eating and personal hygiene. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 3 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0578 Level of Harm - Minimal harm or potential for actual harm During a concurrent record review and interview on 1/5/2024 at 10:35 am, there was no document in Resident 47's clinical record that indicate advance directive information was offered to Resident 47 or Resident 47's representative. The Minimum Data Set Nurse (MDS Nurse) stated there was no documented evidence the AD information was offered to Resident 47 or Resident 47's representative. The MDS Nurse stated the AD information document needed to be on Resident 47's chart if the information was provided. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 4 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0641 Ensure each resident receives an accurate assessment. 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 three sampled residents (Resident 14) reviewed for communication/sensory was assessed accurately. For Resident 14, the admission assessment for hearing was not accurately assessed to reflect Resident 14's hearing problem. Residents Affected - Few This deficient practice had the potential risk for Resident 14's hearing problem not identified and worsen. Findings: During a review of Resident 14's admission record, the admission record indicated the resident was admitted to the facility on [DATE] with diagnoses that included Acute Myocardial Infarction (permanent damage to the heart muscle due to inadequate oxygen supply), Type II Diabetes Mellitus (high levels of sugar in the blood) with Diabetic Neuropathy (a complication of diabetes that affect the nerves that control movement, sensation and other functions), and unspecified epilepsy (brain disorder in which a person has repeated seizures [convulsions] over time). During a review of Resident 14's Initial admission assessment dated [DATE], the assessment indicated Resident 14's ability to hear was adequate with no difficulty in normal conversation, social interaction, and listening to the television (TV). The initial admission assessment indicated Resident 14 does not use any hearing aids or appliances for hearing. During a review of Resident 14's Minimum Data Set (MDS, a standardized assessment and care planning tool) dated 11/14/2023, the MDS indicated Resident 14 usually has the ability to make self understood and understand others. The MDS indicated Resident 14 has adequate hearing with no difficulty in normal conversation, social interaction, or listening to her television (TV). During a review of Resident 14's History and Physical (H&P) dated 11/20/2023, the H&P indicated Resident 14 does not have the capacity to understand and make decisions because of resident's intellectual disability (disorders that begin in childhood and are characterized by intellectual difficulties). During an observation and concurrent interview with Resident 14 on 1/2/2024 at 11:38 a.m., Resident 14 was observed sitting on her bed, awake and watching TV shared by other residents in the room. Resident 14 had difficulty answering questions and stated she had hearing problems. Resident 14 stated that she liked to watch TV but sometimes could not hear well. During an observation and concurrent interview of Resident 14 with Minimum Data Set Nurse (MDS Nurse) on 1/3/2024 at 4:17 p.m., Resident 14 was observed watching her iPad (an electronic device used to watch movies, listen to music, and play games). Resident was observed using an earphone while watching on her iPad which she took off when MDS Nurse greeted her. Resident 14 told MDS Nurse that sometimes she could not hear very well so she used the earphone for her iPad. When MDS Nurse asked Resident 14 about her hearing problem, Resident 14 stated, her hearing problem comes and goes and stated it started when she was admitted to the facility. Resident 14 stated occasionally she had pain in her right ear which also comes and goes. Resident 14 told MDS Nurse she currently has 5/10 pain on her ear (Pain Scale: 0no pain and 10-worst pain). Resident 14 stated she told nursing staff about her hearing problem a while back, but nobody had checked on it. Resident 14 was unable to recall which (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 5 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0641 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete nursing staff she told her hearing problem. Resident 14 told MDS Nurse her hearing problem was bothering her. During a review of the facility's Policy and Procedure (P&P) titled Significant Change in Condition, Response, under the Quality-of-Care section, revised February 1, 2023, the P&P indicated the facility will ensure each resident receives quality of care and services to attain and maintain the highest practicable physical mental and psychosocial well being. The P&P indicated at any time it is recognized by any one of the team members that the condition or care needs of the resident have changed, the Licensed Nurse or Nurse Supervisor should be made aware, and the Nurse will perform and document an assessment of the resident and identify need for additional interventions. Event ID: Facility ID: 055187 If continuation sheet Page 6 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0676 Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason. 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 provide an effective communication method to one of one non-English speaking sampled resident (Resident 185). Residents Affected - Few This deficient practice had the potential for Resident 185 to not be able to express needs which may result in Resident 185 not receiving necessary care and services. Findings: During a review of Resident 185's admission Record, the admission record indicated Resident 185 was admitted on [DATE], with diagnoses that included hemiplegia and hemiparesis (hemiplegia is paralysis of partial or total body function on one side of the body, hemiparesis is one sided weakness, but without complete paralysis) and difficulty walking. During a review of Resident 185's Minimum Data Set (MDS, a resident assessment and care screening tool) dated 12/30/2023, the MDS indicated Resident 185 had clear speech, usually understood others, and usually made self-understood. The MDS indicated Resident 185 was dependent (helper does all of the effort) on dressing, rolling left and right, and chair/bed-to-chair transfer. During a review of Resident 185's Social Determinants of Health Interview Form dated 12/29/2023, the form indicated Resident 185's preferred language was Mandarin (Chinese dialect). During an observation and concurrent interview on 1/3/2023 at 10:17 am, Certified Nursing Assistant 1 (CNA1) was in Resident 185 room repositioning Resident 185. Resident 185 was speaking Mandarin to CNA1 requesting a change of position, and CNA1 did not understand. CNA1 stated she could not understand Resident 185 because the resident only spoke Chinese. CNA1 stated the facility had a communication board to communicate with non-English speaking residents. CNA1 stated the communication board did not cover all the care areas that the resident requested. CNA1 stated that good communication could improve the quality of care provided to the residents, affecting the residents quality of life. During an interview on 1/3/2024 at 3:03 pm, Social Service Director (SSD) stated the facility needed to provide a more effective way to communicate with Resident 185 besides the communication board, so that staff would know the resident's needs better and provide better care to improve Resident 185's quality of life. During an observation and concurrent interview on 1/4/2024 at 8:43 am, Licensed Vocational Nurse 3 (LVN 3) administered medication to Resident 185. LVN 3 was talking to Resident 185 in English and Resident 185 did not understand what LVN 3 said. Resident 185 told Surveyor 1 who was Mandarin speaking, that Resident 185 did not understand what LVN 3 said. Resident 185 told Surveyor 1 it was hard to communicate with facility staff due to language barrier. Resident 185 stated it could affect his care because staff did not understand his needs. During a review of the facility's Policy and Procedure (P&P) titled, Non-English & Aphasic (unable to speak) Residents, Communication for, revised 2/2023, the P&P indicated, The facility will also provide interpreter services for non-English speaking residents. Social services determine the language or tool needed for interpreter services and contact appropriate agency and/or staff or family (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 7 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0676 member who can interpret. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 8 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0685 Assist a resident in gaining access to vision and hearing 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 three sampled residents (Resident 14) reviewed for communication/sensory was provided necessary treatment and/or services for resident's difficulty in hearing. Resident 14 had problems with hearing and was not addressed. Residents Affected - Few This deficient practice had the potential risk for Resident 14's hearing problem to get worse. Cross reference F641. Findings: During a review of Resident 14's admission record, the admission record indicated the resident was admitted to the facility on [DATE] with diagnoses that included Acute Myocardial Infarction (permanent damage to the heart muscle due to inadequate oxygen supply), Type II Diabetes Mellitus (high levels of sugar in the blood) with Diabetic Neuropathy (a complication of diabetes that affect the nerves that control movement, sensation and other functions), and unspecified epilepsy (brain disorder in which a person has repeated seizures [convulsions] over time). During a review of Resident 14's Initial admission assessment dated [DATE], the assessment indicated Resident 14's ability to hear was adequate with no difficulty in normal conversation, social interaction, and listening to the television (TV). The initial admission assessment indicated Resident 14 does not use any hearing aids or appliances for hearing. During a review of Resident 14's Minimum Data Set (MDS, a standardized assessment and care planning tool) dated 11/14/2023, the MDS indicated Resident 14 usually has the ability to make self understood and understand others. The MDS indicated Resident 14 has adequate hearing with no difficulty in normal conversation, social interaction, or listening to her television (TV). During a review of Resident 14's untitled care plan dated 11/22/2023, the care plan indicated the resident was at risk for communication problem related to resident being usually understood (difficulty communicating some words or finishing thoughts but is able to if prompted or given time) and usually understands (missing some part or intent of the message but can comprehend most conversation). The care plan goals were for Resident 14 to maintain current level of communication function, be able to make basic needs known on a daily basis, and to communicate basic wants and needs verbally. The care plan interventions included to anticipate and meet resident's needs, assist with word finding as needed/appropriate, encourage resident to continue stating thoughts even if resident is having difficulty and Occupational and Physical Therapy evaluation and treatment per physician's orders. During a review of Resident 14's History and Physical (H&P) dated 11/20/2023, the H&P indicated Resident 14 does not have the capacity to understand and make decisions because of resident's intellectual disability (disorders that begin in childhood and are characterized by intellectual difficulties). During an observation and concurrent interview with Resident 14 on 1/2/2024 at 11:38 a.m., Resident 14 was observed sitting on her bed, awake and watching TV shared by other residents in the room. Resident 14 had difficulty answering questions and stated she had hearing problems. Resident 14 stated that she liked to watch TV but sometimes could not hear well. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 9 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0685 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During an observation and concurrent interview of Resident 14 with Minimum Data Set Nurse (MDS Nurse) on 1/3/2024 at 4:17 p.m., Resident 14 was observed watching her iPad (an electronic device used to watch movies, listen to music, and play games). Resident was observed using an earphone while watching on her iPad which she took off when MDS Nurse greeted her. Resident 14 told MDS Nurse that sometimes she could not hear very well so she used the earphone for her iPad. When MDS Nurse asked Resident 14 about her hearing problem, Resident 14 stated, her hearing problem comes and goes and stated it started when she was admitted to the facility. Resident 14 stated occasionally she had pain in her right ear which also comes and goes. Resident 14 told MDS Nurse she currently has 5/10 pain on her ear (Pain Scale: 0no pain and 10-worst pain). Resident 14 stated she told nursing staff about her hearing problem a while back, but nobody had checked on it. Resident 14 was unable to recall which nursing staff she told her hearing problem. Resident 14 told MDS Nurse her hearing problem was bothering her. During a review of the facility's Policy and Procedure (P&P) under Quality of Care for ADL (Activities of Daily Living), Services to Carry Out, reviewed on February 2023, the P&P indicated it is the facility's policy that residents are given the appropriate treatment and services to maintain or improve his/her abilities. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 10 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 observation, interview, and record review, the facility failed to ensure the Low Air Loss Mattress (LAL mattress, a pressure reducing device that helps prevent skin breakdown) settings for four of four sampled residents (Residents 68, 66, 31 and 32) were carried out as ordered by the physician and/or as recommended by the manufacturer. Residents Affected - Some a. For Resident 68, the facility failed to ensure the LAL setting was according to the resident's weight as ordered by the physician and as recommended by the manufacturer. b. For Resident 66, the facility failed to ensure the LAL setting was according to the resident's weight as ordered by the physician and as recommended by the manufacturer. c. For Resident 31, the facility failed to ensure the LAL mattress setting was accurate. d. For Resident 32, the facility failed to ensure the LAL mattress setting was accurate. These deficient practices had the potential to worsen Residents 68 and 31's pressure ulcer (lesion/wound caused by unrelieved pressure that results in damage of underlying tissue) and placed Residents 66 and 32 at risk to develop pressure ulcer. Findings: a. During a review Resident 68' admission record, the admission record indicated Resident 68 was admitted to the facility on [DATE], with diagnoses that included paraplegia (paralysis of the legs and lower body, typically caused by spinal injury or disease), pressure ulcer of the right buttock Stage 2 (partial thickness loss of dermis [thicker, deeper layer of the skin underlying the epidermis [upper or outer layer of the skin] presenting as a shallow open ulcer [open sore] with a red pink wound bed) and Muscle Wasting and Atrophy (thinning or loss of muscle tissue). During a review Resident 68's History and Physical (H&P) dated 9/26/2023, the H&P indicated Resident 68 had the capacity to understand and make decisions. During a review of Resident 68's Minimum Data Set (MDS, a standardized assessment and care screening tool) dated 10/23/2023, the MDS indicated Resident 68 has the ability to make self understood and understand others. The MDS indicated Resident 68 was dependent on staff for shower, lower body dressing, and chair/bed to chair transfer. The MDS indicated Resident 68 required substantial/maximal assistance for toileting hygiene and mobility for rolling left or right, sitting to lying, and lying to sitting. The MDS indicated Resident 68 is at risk for developing pressure ulcers, and at the time of the assessment, the resident did not have any unhealed pressure ulcer. The MDS indicated Resident 68 had a pressure reducing device for his bed. During a review of Resident 68's Physician's Order Summary, the order summary indicated an order for a Low Air Loss Mattress, dated 10/3/2023, for tissue load management; setting based on weight. During a review of Resident 68's Weights and Vitals Summary, the summary indicated Resident 68's weight on 1/1/2024 was 119 pounds (lbs.) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 11 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 - Some During an interview with Resident 68 on 1/2/2024 at 3:41 pm, Resident 68 stated the LAL mattress was to protect his back. Resident 68 stated he noticed the LAL mattress felt too hard and he asked a nurse to adjust the setting. Resident 68 stated the nurse (unidentified) came into his room and adjusted the mattress pressure. Resident 68 stated the LAL mattress still felt tough on his back. During an observation and concurrent interview with Licensed Vocational Nurse 4 (LVN 4) on 1/2/2024 at 3:55 pm, Resident 68's LAL mattress setting was on two lighted bars. LVN 4 stated Resident 68's LAL mattress setting was on two and Resident 68's weight was 119 lbs. LVN 4 stated she will ask the Treatment Nurse for the accurate LAL mattress setting for Resident 68. During an interview with Treatment Nurse (TN) on 1/2/2024 at 4:10 pm, TN verified the setting on Resident 68's LAL mattress was on two. TN stated Resident 68's weight was 119 lbs., and the accurate LAL mattress setting for Resident 68 needed to be on one and not two. During a review of the facility's Policy and Procedure (P&P) titled Low Air Loss, Alternating Pressure, dated revised in February 2023, indicated to use Low Air Loss, alternating-pressure mattress or other type of mattresses as prescribed by physician to prevent skin breakdown and to treat pressure ulcers. Attached to the P&P was the User Manual for the LAL mattress. The User Manual indicated LAL Mattress Reference Table for Weight and Comfort Level indicated for residents weighing 90 to 120 lbs. the setting needed to be one (1 lighted bar). b. During a review of Resident 66's the admission record, the admission record indicated Resident 66 was admitted to the facility on [DATE], with diagnoses that included Orthopedic Aftercare Following Surgical Amputation (aftercare for patient who had a surgical procedure for the removal of a body part ), type II diabetes mellitus (high levels of sugar in the blood) with diabetic neuropathy (a complication of diabetes that affect the nerves that control movement, sensation and other functions), and Muscle Wasting and Atrophy. During a review of Resident 66's MDS dated [DATE], the MDS indicated Resident 66 has the ability to make self understood and understand others. The MDS indicated Resident 66 was dependent on staff for toileting hygiene, shower, lower body dressing, mobility for sitting to standing position, and transfer to a bed from a chair. The MDS indicated Resident 66 was at risk for developing pressure ulcers, and at the time of the assessment, Resident 66 did not have any unhealed pressure ulcer. The MDS indicated Resident 66 had a pressure reducing device for his bed. During a review of Resident 66's H&P dated 7/1/2023, the H&P indicated Resident 66 had the capacity to understand and make decisions. During a review of Resident 66's Physician's Order Summary, the order summary indicated an order for Low Air Loss Mattress dated 9/11/2023 for tissue load management; setting based on weight. During a review of Resident 66's Weights and Vitals Summary, the summary indicated Resident 66's latest weight on 12/7/2023 was 142.6 lbs. During an observation and concurrent interview with Treatment Nurse (TN) on 1/2/2024 at 4:05 pm, Resident 66's LAL mattress setting was on three lighted bars. TN verified the setting was on 3 lighted bars. TN stated Resident 66's weight was 142 pounds lbs. and the accurate LAL mattress setting for Resident 66 should be on two and not three. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 12 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 - Some During a review of the facility's Policy and Procedure (P&P) titled Low Air Loss, Alternating Pressure, revised February 2023, the P&P indicated to use Low Air Loss, alternating-pressure mattress or other type of mattresses as prescribed by physician to prevent skin breakdown and to treat pressure ulcers. Attached to the P&P was the User Manual for the LAL mattress. The User Manual indicated LAL Mattress Reference Table for Weight and Comfort Level indicated for residents 115 to 145 lbs., the setting needed to be two (2 lighted bars). d. During a review of Resident 32's admission Record, the admission record indicated Resident 32 was admitted on [DATE], with diagnoses that included absence of left and right leg below knee (left and right leg below knee surgical amputation) and muscle weakness. During a review of Resident 32's MDS dated [DATE], the MDS indicated Resident 32 had clear speech, sometimes understood others, and sometimes made self-understood. Resident 32 was dependent (helper does all of the effort) on dressing, rolling left and right, and chair/bed-to-chair transfer. During an observation on 1/2/2024 at 3:25 pm, Resident 32 was lying in bed on a LAL mattress. Resident 32's LAL mattress was set at static (the feature allowing air to fill all the cells in mattress at the same time and suspends the alternating feature of the mattress). During an interview on 1/2/2024 at 3:28 pm, LVN 1 stated Resident 32 had a history of pressure injury (lesion/wound caused by unrelieved pressure that results in damage of underlying tissue) and was at risk for pressure injury again. LVN 1 stated Resident 32's LAL mattress should not be set at static mode and needed be set up at alternative mode to prevent pressure injury. During a review of the facility's Policy and Procedure (P&P) titled, Low Air Loss, Alternating Pressure Pad or Mattress, revised 2/2023, the P&P indicated, To use Low Air Loss, alternating-pressure mattress or other type of mattresses as prescribed by physician to prevent skin breakdown and to treat pressure ulcers. Low Air Loss mattress will be set up and serviced according to manufacturer's recommendations. During a review of the manufacture's user manual titled Power Pro Elite Mattress System, the manual indicated, The Power Pro Elite Mattress System offers patients a comfortable and relaxing support surface by using the established principles of alternating therapy, which can both prevent skin breakdown and enhance healing. c. During a review of Resident 31's admission Record indicated, the admission record indicated the facility admitted the resident on 2/8/2023 and readmitted on [DATE], with diagnoses that included Stage 3 Pressure Ulcer (ulcer that extends into the underlying subcutaneous tissue layer, but not all the way to the bone). During a review of Resident 31's MDS dated [DATE], the MDS indicated the resident was able to express ideas and able to understand verbal content. The MDS indicated Resident 31 had severe cognitive (ability to understand) impairment. The MDS indicated Resident 31 was totally dependent with eating and shower and required maximum assistance with bed mobility and personal hygiene. During a review of Resident 31's Care Plan for pressure ulcer on the sacrococcyx, initiated on 12/19/2023, the care plan indicated interventions for Resident 31 to use LAL mattress for tissue load management. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 13 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 During an observation on 1/4/2024 at 7:32 am, Resident 31 was lying in bed on his right side with a low air loss mattress (LAL mattress). Resident 31's LAL mattress was set at Static (the mattress will not alternate air cells and remain in a static position,). The mattress had two comfort control switch, soft control switch on the left and firm control switch on the right. The mattress had lights on top from 1 to 8 to show how soft or firm the mattress was set and the light indicated 8 to the right side. Residents Affected - Some During a concurrent observation on 1/4/2024 at 8:50 am, Resident 31 was lying in bed on his right side with a LAL mattress and the LAL mattress was set at Static with air mattress set at 8. Licensed Vocational Nurse 2 (LVN 2) stated Resident 31's bed was set at static and the device was set to the firm setting. During a concurrent observation on 1/4/2024 at 8:56 am, the Director of Staff Development (DSD) stated Resident 31's LAL mattress was set at firm setting. The DSD stated Resident 31's mattress needed to be set at 3 based on Resident 31's weight and the light needed to be on 3 not 8, The DSD touched Resident 31's mattress and stated the mattress felt firm. The DSD stated staff use the static setting during adult brief change. The DSD stated, Resident 31 who had a pressure ulcer (lesion/wound caused by unrelieved pressure that results in damage of underlying tissue) would not benefit from a LAL mattress on static setting. During a wound observation and interview on 1/4/2024 at 10:40 am, Resident 31 had the following pressure ulcers: -Stage 3 pressure ulcer on the sacrococcyx (lower back and tailbone) -Deep Tissue Injury (pressure-related injury to subcutaneous tissues under intact skin) on the right and left heel. In a concurrent interview, the Treatment Nurse (TXN) stated Resident 31 weighed 122 pounds (lbs.) and Resident 31's LAL mattress needed to be set at 3 based on Resident 31's weight. During a review of the LAL mattress Manufacturer's Manual, the manual indicated comfort level controls the air pressure output level. Press Firm button and the output pressure will increase, and higher-pressure output will support heavier weight patient, for decreasing air pressure, vice versa. The Manual identified a table titled Weight and Comfort Level Reference and the table indicated those weighing 122 lbs., the setting will be at Light 3. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 14 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** b. During a review of Resident 32's admission Record, the admission record indicated Resident 32 was admitted on [DATE], with diagnoses that included absence of left and right leg below knee (left and right leg below knee surgical amputation) and muscle weakness. During a review of Resident 32's Order Summary Report dated 11/7/2023, the order indicated for staff to provide Resident 32 a cushion alarm in bed for poor safety awareness and to monitor placement and function every shift. During a review of Resident 32's MDS dated [DATE], the MDS indicated Resident 32 had clear speech, sometimes understood others, and sometimes made self-understood. The MDS indicated Resident 32 was dependent (helper does all of the effort) on dressing, rolling left and right, and chair/bed-to-chair transfer. During an observation and concurrent interview on 1/2/2024 at 3:51 pm, Resident 32 was lying in bed. There was a pad alarm (a pad placed under a resident while on the bed and sends an alarm to alert staff when the resident gets up from pad) on Resident 32's bed and connected to a monitor. The monitor was not turned on. LVN 1 stated Resident 32 had a history of falling, and the physician ordered pad alarm for him. LVN 1 stated Resident 32's pad alarm needed to be turned on while he was in bed for fall prevention. LVN 1 stated if Resident 32 would fall, Resident 32 could get injured which would decrease his mobility, affecting his quality of life. LVN 1 stated, staff needed to ensure Resident 32's bed alarm was turned on while the resident was in bed or in a chair. During a review of the facility's Policy and Procedure titled, Medical Device, Consent, Obtaining, revised 2/2023, the P&P indicated, for the use of safety devices such as sensor pad alarms, or other restraints (devices), the facility follows manufactures guidelines during administration and placement of safety devices. Based on observation, interview, and record review, the facility failed to provide an environment free of accident hazard for two of four sampled residents (Residents 50 and 32) by failing to: a. Utilize bilateral landing mats for Resident 50 who had history of fall, as ordered. b. Ensure Resident 32's pad alarm ( a pad placed under a resident while on the bed and sends an alarm to alert staff when the resident gets up from pad) was turned on while the resident was in bed for fall prevention, as ordered. These deficient practices had the potential to result in serious consequences of fracture (break in the bone) and/or bleeding that may accompany a fall. Findings: a. During a review of Resident 50's admission record indicated, the facility admitted Resident 50 on 6/18/2021 with diagnoses that included unspecified dementia (long term and often gradual decrease in the ability to think and remember severe enough to affect a person's daily functioning), difficulty in walking, muscle weakness and history of falling. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 15 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0689 Level of Harm - Minimal harm or potential for actual harm During a review of Resident 50's History and Physical (H&P), dated 6/24/2021, the H&P indicated Resident 50 did not have the capacity to understand and make medical decisions. During a review of Resident 50's Order Summary Report, dated 7/2/2021, the order report indicated to provide adjustable bed in lowest position with floor mats for fall reduction measures. Residents Affected - Some During a review of Resident 50's untitled care plan initiated on 2/26/2023, the care plan indicated Resident 50 was at risk for falls related to gait (a manner of walking or moving) or balance problems. The care plan indicated for staff to adjust the bed in lowest position with floor mats for fall reduction measures. During a review of Resident 50's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 11/23/2023, the MDS indicated, Resident 50 had moderately impaired cognition (mental action or process of acquiring knowledge and understanding) for daily decision making. The MDS indicated Resident 50 required total dependence with eating, oral and toileting hygiene, shower, upper and lower body dressing. During a review of Resident 50's Fall Risk Evaluation (method of assessing a patient's likelihood of falling), dated 11/23/2023, the evaluation indicated Resident 50 was assessed as at high risk for fall due to disorientation, regularly incontinent (involuntary leakage of urine from the bladder) and predisposing disease condition. During a concurrent observation and interview on 1/2/2024 at 10:06 am, with Registered Nurse Supervisor (RNS), Resident 50 was awake lying in bed and bilateral floor mats were placed approximately 1 foot away from Resident 50's bed. RNS stated floor mats needed to be closer to Resident 50's bed to catch Resident 50 in case of a fall. RNS stated Resident 50 was high risk for fall and the purpose of the bilateral floor mats was to minimize injury in case Resident 50 would fall. During a concurrent interview and record review on 1/3/2024 at 9:52 am with the Minimum Data Set Coordinator (MDSC), Resident 50's care plan was reviewed. MDSC stated nursing staff should place bilateral floor mats next to Resident 50's bed to catch and minimize injury in case Resident 50 would fall. During an interview on 1/4/2024 at 11:27 am with the facility's Director of Nursing (DON), the DON stated floor mats needed to be properly placed next to Resident 50's bed to minimize potential injury in case resident would fall. During a review of the facility's Policy and Procedure (P&P) titled, Fall Management System, revised 2/2023, the P&P indicated, to provide each resident with appropriate assessment and intervention to prevent falls and to minimize complications if a fall occurs. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 16 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. Based on observation, interview and record review, the facility failed to assess and monitor the presence of white sediments (visible particles in the urine that may contain red or white blood cells, casts, bacteria, fungi, parasites in the urine that could indicate infection or dehydration [fluid deficit]) in the urine for one of five sampled residents (Resident 22) with indwelling catheter (foley catheter - a tube inserted in the bladder to drain urine into a drainage bag), as indicated in the facility's policy and procedure, titled Catheter Drainage Bag and the resident's care plan for foley catheter. This deficient practice had the potential for Resident 22 to not receive care or delayed care and treatment for urinary tract infection (UTI, condition in which bacteria invade and grow in any part the urinary system). Findings: During a review of Resident 22's admission record, the admission record indicated the facility admitted Resident 22 on 8/22/2022 with diagnoses that included personal history of UTI, neuromuscular dysfunction of the bladder (the nerves and muscles don't work together very well causing the bladder to not fill or empty correctly). During a review of Resident 22's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 6/24/2023, the MDS indicated, Resident 22 had severely impaired cognition (mental action or process of acquiring knowledge and understanding) for daily decision making. The MDS indicated Resident 22 required extensive assistance with two-person physical assistance with bed mobility, transfer (how resident moves between surfaces including to or from bed, chair, wheelchair, standing position), and dressing. During a review of Resident 22's untitled care plan, initiated on 7/26/2023, the care plan indicated Resident 22 required foley catheter due to neurogenic bladder (bladder does not empty or store urine properly due to brain/nerve problem). The plan of care indicated, Resident 22 was at risk for UTI and recurrence of UTI. The care plan goals included to show no signs and symptoms of UTI. The care plan interventions included for nursing staff to monitor for signs/symptoms of discomfort on urination and frequency. During a review of Resident 22's Physicians Order, dated 12/26/2023, the order indicated to insert foley catheter to Resident 22 for neurogenic bladder. During an observation on 1/2/2024 at 10:43 am, Resident 22 was asleep on a geriatric chair (Geri chair large, padded chairs with wheeled bases, and are designed to assist residents with limited mobility). Resident 22 had foley catheter hanging by the right side of the Geri chair. Resident 22's foley catheter tube and urinary collecting bag had white sediments in it. During a concurrent observation and interview on 1/2/2024 at 10:50 am, with Registered Nurse Supervisor (RNS), the RNS stated there were white sediments in Resident 22's urinary tube and bag. RNS stated she needed to notify the attending physician of the white sediments in Resident 22's urinary tube and bag. RNS stated Resident 22's foley catheter needed to be monitored for signs and symptoms of UTI (such as presence of sediments in Resident 22's urinary tube and bag) by licensed nurses every (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 17 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0690 eight (8) hours to prevent infection. Level of Harm - Minimal harm or potential for actual harm During a review of the facility's Policy and Procedure (P&P) titled, Catheter Drainage Bag, revised 1/2023, the P&P indicated, staff must observe urine for color, consistency, odor, or foreign particles. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 18 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0695 Provide safe and appropriate respiratory care for a resident when needed. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure correct oxygen flow rate was administered to one of one sampled resident (Resident 25) Residents Affected - Few This deficient practice had the potential to result in complications associated with oxygen (odorless and colorless reactive gas) therapy (treatment that provides extra oxygen to breathe in). Findings: During a review of Resident 25's admission Record, the admission record indicated the facility admitted the resident on 7/11/2023, with diagnoses that included acute and chronic respiratory failure (a condition when the lungs cannot get enough oxygen into the blood). During a review of Resident 25's Minimum Data Set (MDS - a standardized assessment and care planning tool) dated 8/5/2023, the MDS indicated the resident had no cognitive (ability to understand and process information) impairment and required extensive assistance with bed mobility, dressing and personal hygiene. During a review of Resident 25's recapped Physician Orders dated 12/30/2023, the order indicated for Resident 25 to receive oxygen at 2 l/min via nasal cannula/mask (a small, flexible tube that delivers oxygen though the nose or via mask) as needed to keep oxygen saturation (a measure of how much oxygen the blood is carrying as a percentage of the maximum it could carry) above 90%. During an observation on 1/2/2024 at 12:42 pm, Resident 25 was lying in bed with ongoing oxygen via nasal cannula at 5 liters per minute (l/min) by oxygen concentrator (a medical device that extracts oxygen from the air and filter it into purified oxygen for breathing.) During a concurrent observation and interview on 1/3/2024 at 4:30 pm, Resident 25 was lying in bed with ongoing oxygen via nasal cannula at 5 l/min. LVN 2 changed the oxygen flow rate to 2 l/min and stated Resident 25's order for oxygen was 2 l/min. LVN 2 stated she was the nurse who received the PRN (as needed) order for oxygen 2 l/min for Resident 25. LVN 2 stated she was assigned to Resident 25 on 1/2/2024 and 1/3/2024. LVN 2 stated she did not set the oxygen flow rate to 5 l/min., and it could have been the nurses from the other shifts changed the oxygen flow rate. LVN 2 stated she did not look at the oxygen flow rate for Resident 25 during her shift. LVN 2 stated if Resident 25 required 5 l/min of oxygen, Resident 25's attending physician needed to be notified because there could be underlying reasons why Resident 25 required more oxygen than ordered. During an observation on 1/3/2024 at 4:44 pm, LVN 2 checked Resident 25's oxygen saturation reading while Resident 25 was on oxygen at 2 l/min. Resident 25's oxygen saturation was 95%. During a review of Resident 25's Vital Signs Summary, the summary indicated the following oxygen saturation readings: On 1/2/2024 at 3:54 pm- 96% on oxygen via nasal cannula On 1/3/2024 at 8:47 pm- 96% on room air On 1/3/2024 at 12 midnight- 98% on oxygen via nasal cannula (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 19 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0695 During a review of the facility's Policy and Procedure (P&P) titled Oxygen Therapy dated 2/2023, the P&P indicated it is the policy of the facility that oxygen therapy is administered, as ordered by the physician. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 20 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to perform a Gradual Dose Reduction (GDR, an attempt to decrease or discontinue) for two of five sampled residents (Residents 55 and 41) in accordance with the facility's Policy and Procedure titled, Psychotropic Drug Use. a. There was no GDR completed for Resident 55 who received Remeron (a medication to treat depression [a feeling of severe sadness or hopelessness]) with no symptoms of depression for 11 months. b. There was no GDR completed for Resident 41 who received Risperdal (a medication to treat schizophrenia [mental disorder characterized by abnormal social behavior and failure to understand what is real]) since 1/21/2021. This deficient practice resulted in Residents 55 and 41 receiving psychotropic (drug that affects brain activities associated with mental processes and behavior) medication without adequate clinical reason for use and had the potential to result in adverse consequences for Residents 55 and 41. Findings: During a review of Resident 55's admission record, the admission record indicated the facility admitted Resident 55 on 7/23/2021 with diagnoses that included dementia (long term and often gradual decrease in the ability to think and remember severe enough to affect a person's daily functioning) and depression. During a review of Resident 55's Minimum Data Set (MDS, a standardized assessment and care planning tool), dated 10/27/2023, the MDS indicated, Resident 55's cognition (ability to understand) for daily decision making was moderately impaired. The MDS indicated Resident 55 was independent in eating, oral hygiene upper and lower body dressing, and personal hygiene. During a concurrent interview and record review of Resident 55's Medication Administration Record (MAR) on 1/3/2023 at 4:04 pm with Licensed Vocational Nurse 1 (LVN 1), the MAR indicated Resident 55 received Remeron 15 mg daily and Resident 55 did not verbalize feelings of sadness and hopelessness from 7/2023 to 1/3/2024. LVN 1 stated she did not see or observed Resident 55 being sad or depressed and Resident 55 did not verbalize hopelessness. LVN 1 stated, Resident 55's order for Remeron needed to be reduced gradually because Resident 55 did not have any behavior of being depressed since 7/2023. During a review of Resident 55's Physician Order, dated 1/27/2023, the order indicated for staff to administer to Resident 55 Remeron tablet 15 milligram (mg) one tablet by mouth at bedtime for depression manifested by verbalizing feelings of sadness and hopelessness. During a concurrent interview and record review on 1/4/2024 at 11:01 am of Resident 55's Psychotropic Summary Sheet initiated on 1/28/2023 with the facility's Director of Nursing (DON), Resident 55's Psychotropic Summary Sheet indicated from 8/1/2023 to 11/2023, Resident 55 did not have any symptoms of depression. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 21 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0758 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a concurrent interview and record review of Resident 55's MAR on 1/4/2024 at 11:03 am with the facility's Director of Nursing (DON), the DON stated Resident 55 did not have any episodes of verbalizing sadness and hopelessness for the past 11 months (2/2023 until 1/2024). The DON stated there was no documentation in Resident 55's clinical record that a GDR for the use of Remeron was performed since 1/2023 until 1/3/2024. The DON stated GDR of Remeron for Resident 55 needed to be done/attempted. The DON stated it was important to perform GDR to residents on psychotropic medications to ensure the residents were not receiving higher dose of psychotropic medications that can cause harmful effect to the residents. During a concurrent observation and interview on 1/4/2023, at 11:56 am, together with Treatment Nurse (TN), Resident 55 smiled and was in good spirit. TN stated, she has not heard Resident 55 verbalized that he was sad. Resident 55 stated, his heart was happy with no sadness. During a review of the facility's Policy and Procedure titled, Psychotropic Drug Use, dated 2/2023, the P&P indicated that upon initial comprehensive assessment, . residents will be referred to the facility's Psychotropic Drug Review Committee and/or Psychiatrist to ensure attempt/consider a GDR, if appropriate. The P&P indicated, quarterly thereafter, or with any significant change in condition, the residents will be calendared by the SSD for referral to the Psychotropic Drug Review Committee to assess for continued need/justification of the medication and possible gradual dose reduction. b. During a review of Resident 41's admission Record, the admission record indicated the facility admitted the resident on 6/11/2020, with diagnoses that included schizophrenia (mental disorder characterized by abnormal social behavior and failure to understand what is real). During a review of Resident 41's MDS dated [DATE], the MDS indicated the resident was able to express ideas and wants and was able to understand verbal content. The MDS indicated Resident 41 had delusions (misconceptions or beliefs that are firmly held, contrary to reality,) and had no physical, verbal, and other behavioral symptoms directed toward others. During a review of Resident 41's recapped Physician Orders for the month of January 2024 with the Minimum Data Set (MDS) Nurse, the Physician Orders indicated the following current orders; - Risperdal 3 milligrams(mg) 1 tablet by mouth twice a day for paranoia related to schizophrenia as evidenced by believing people were poisoning her/stealing from her. The order was initiated on 2/1/2023. - Monitor and record number of episodes of paranoia as evidenced by believing people were poisoning her/stealing from her every shift. During an observation on 1/3/2024 at 1:53 pm, Resident 41 was inside the activity room, sitting in a wheelchair participating in activities, calm and pleasant. During a review of the Monitoring for Behavior of Paranoia and a concurrent interview with the MDS Nurse on 1/4/2024 at 12:03 pm, the monitoring indicated the following: June 2023 - 0 episode July 2023 - 0 episode (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 22 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0758 August 2023 - 1 episode Level of Harm - Minimal harm or potential for actual harm September 2023 - 1 episode October 2023 - 1 episode Residents Affected - Some November 2023 -1 episode December 2023 -0 episode During a review of the Psychiatric Nurse Practitioner notes dated 12/26/2023 with the Director of Nursing (DON) on 1/4/2024 at 12:26 pm, the notes indicated there were multiple GDR attempts with no dates specified. During a concurrent interview, the DON stated she did not have the information regarding the GDR attempts, the information would be with the Social Services Director. The DON stated, the documentation on GDR needed to be on Resident 41's paper or electronic chart. During a review of Resident 41's Medication Regimen Review (MRR) dated 5/16/23 and 11/17/23 on 1/5/2024 at 11:26 am, the MRR indicated a recommendation for a psychotropic drug regimen review with evaluation for dose reduction, with the Director of Nursing (DON). The MRR indicated it was clinically contraindicated because target symptoms returned or worsened after a past GDR and Resident 41 was currently receiving the lowest dose of Risperdal to maintain functional capacity with no dose change indicated. During a concurrent interview with the DON on 1/5/2024 at 11:26 am, the DON stated she did not know why there was a checkmark on the Medication Regimen Review indicating the resident was currently receiving the lowest dose of Risperdal. The DON did not answer how it was determined Resident 41 received the lowest dose of Risperdal. During a review of Resident 41's Physician Orders for Risperdal on 1/5/2024 at 11:42 am, the physician's order indicated the following, since admission [DATE]): On 6/2/2020, Risperdal 2 mg every AM On 7/25/2020, Risperdal 2 mg every AM On 1/21/2021, Risperdal 0.5 mg twice a day On 8/6/2021, Risperdal 0.5 mg twice a day On 9/4/2021, Risperdal 0.75 mg twice a day On 9/9/2021, Risperdal 1 mg twice a day On 12/30/2022, Risperdal 2 mg twice a day On 2/1/2023, Risperdal 3 mg twice a day During a concurrent interview with the DON on 1/5/2024 at 11:42 am, the DON stated the last GDR for Resident 41 for the use of Risperdal was completed on 1/21/2021. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 23 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 0758 Level of Harm - Minimal harm or potential for actual harm During a review of the Social Services Notes from March 2023 to December 2023 and a concurrent interview on 1/5/2024 at 12:34 pm, the Social Services Director stated during her daily interaction with Resident 41, the resident would constantly ask for a snack or go outside to smoke but did not verbalize any thoughts of someone stealing from her or poisoning her. Residents Affected - Some During a review of Resident 41's Social Services Notes, the notes indicated the following: - On 3/11/2023, Resident 41 would walk out of the facility if she did not have her cigarettes. - On 9/18/2023, the Psychiatric Nurse Practitioner saw Resident 41 for medication review. Resident 41 was monitored for mood and behaviors. Resident 41 tends to have the tenacity of walking out of the front lobby if she does not have her snacks or cigarettes. - On 11/10/2023, Resident 41 continued to have the tenacity of wheeling herself out through the lobby door at times when resident ran out of cigarettes or snacks. During a review of the facility's P&P titled Psychotropic Drug Use dated 2/2023, the P&P indicated residents who use psychotropic drugs receive gradual dose reductions, and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs. Psychotropic medications shall not be administered for the purpose of discipline or convenience. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 24 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 interview and record review, the facility failed to ensure infection prevention and control program practices were implemented for two of two sampled residents (Residents 41 and 20), by failing to: Residents Affected - Some a. Ensure the facility administered antibiotics (medicine that fights infection) to Resident 41 with adequate indication for its use. For Resident 41, the criterion was not met for the use of antibiotics based on Mc Geer's criteria (the criteria that define infections for surveillance purposes were selected to increase the likelihood that the events captured by application of the definitions are true infections). This deficient practice had the potential for Resident 41 to develop antibiotic resistance (when bacteria/germs develop the ability to defeat medications designed to kill them). b. Ensure Resident 20's indwelling catheter (known as Foley catheter, a tube that allows urine to drain from the bladder into a bag that is usually attached to the thigh) tube did not touch the floor. This deficient practice placed Resident 20 at risk for infection. Findings: a. During a review of Resident 41's admission Record, the admission record indicated the facility admitted the resident on 6/11/2020, with diagnoses that included schizophrenia (mental disorder characterized by abnormal social behavior and failure to understand what is real) and diabetes mellitus (high blood sugar.) During a review of Resident 41's Minimum Data Set (MDS- a standardized assessment and care planning tool) dated 8/11/2023, the MDS indicated the resident was able to express ideas and wants and was able to understand verbal content. During a review of Resident 41's Physician Orders for December 2023, the order indicated Keflex 500 milligrams, 1 capsule by mouth four times a day for 10 days for urinary tract infection (UTI), initiated on 12/10/2023. During a review of the document titled Infection Surveillance and a concurrent interview on 1/5/2024 at 8:47 am, the document indicated Resident 41 was started on Keflex for urinary tract infection. The document indicated for residents with UTI without an indwelling catheter, both criteria 1 and criteria 2 must be present. Resident 41's Infection Surveillance form indicated Criteria 1 was not met and Criteria 2 was blank. The IPN stated he did not have the documentation for microbiologic sub criteria (urinalysis or urine culture). The IPN stated the process would be for Medical Records to follow up the urinalysis or urine culture result from the General Acute Care Hospital (GACH). During an interview on 1/5/2024 at 8:25 am, the IPN stated the facility used Mc'Geers criteria for Infection Surveillance. During an interview on 1/5/2024 at 9:04 am, the IPN stated Resident 41 came back from GACH with the order for Keflex. IPN stated he wanted to ensure the facility would follow the doctor's order from GACH and asked for a specific order even if the urinalysis result was not available. During an interview on 1/5/24 at 9:06 am, the IPN stated the facility's Medical Records did not have the urinalysis result and did not request the results from GACH. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 25 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 During a review of Resident 41's Urine Culture result dated 12/9/23 and a concurrent interview on 1/5/24 at 10:05 am, the urine culture result had a faxed date of 1/5/24 at 9:22 am. The result indicated organism 1 was Escherichia coli (ESBL). The IPN stated he needed to follow up on the results then he could have found out Resident 41 needed to be placed on isolation for ESBL. The IPN stated oral dose of Keflex would not target ESBL and Resident 41 would have needed intravenous (IV- administration of substance into the vein) antibiotics. During a review of the facility's Policy and Procedure (P&P) titled Antibiotic Stewardship reviewed and revised 5/2023, the P&P indicated it is the policy of the facility to implement an Antibiotic Stewardship Program (ASP) which will promote the appropriate use of antibiotics while optimizing the treatment of infections, at the same time reducing the possible adverse events associated with antibiotic use. This policy has the potential to limit antibiotic resistance in the post-acute setting, while improving treatment efficacy and resident safety, and reducing treatment-related costs. The P&P indicated the facility may consider antibiotic time-out practices. An antibiotic review provides clinicians with an opportunity to reassess the ongoing need for and choice of an antibiotic when the clinical picture is clearer and more information is available. b. During a review of Resident 20's admission Record, the admission record indicated the facility admitted Resident 20 on 4/29/2023 with diagnoses that included urinary tract infection (UTI, condition in which bacteria invade and grow in any part the urinary system) and Benign Prostatic Hyperplasia (BPH - a condition in which an overgrowth prostate tissue pushes against the urethra and the bladder, blocking the flow of the urine) with lower urinary tract symptoms. During a review of Resident 20's History and Physical H&P, dated 4/30/2023, the H&P indicated Resident 20 had the capacity to understand and make decisions. During a review of Resident 20's MDS dated [DATE], the MDS indicated, Resident 20 had moderately impaired cognition (mental action or process of acquiring knowledge and understanding) for daily decision making. The MDS indicated Resident 20 required total dependence with oral/toileting hygiene, shower, personal hygiene and upper/lower body dressing. During a review of Resident 20's Order Summary Report dated 12/26/2023, the report indicated for staff to insert foley catheter French (a type of catheter)12 (size of tubing) to close drainage system for obstructive uropathy (a condition that allows urine to go back up into the ureters [a tube that carries urine from the kidneys to the bladder]) related to BPH. During a review of Resident 20's Situation-Background-Assessment-Recommendation (SBAR - a technique provides a framework for communication between members of the health care team about a patient's condition), dated 11/16/2023, the SBAR indicated Resident 20 had hematuria (blood in the urine), and occasional bladder pain and dysuria (difficulty urinating). During a concurrent observation and interview on 1/2/2024 at 10:59 am, with Registered Nurse Supervisor (RNS), Resident 20's indwelling catheter tubing was touching the floor. RNS stated foley catheter tubing should not be touching the floor because the floor was dirty and can cause cross contamination (the process by which bacteria or other microorganisms are unintentionally transferred from one substance or object to another, with harmful effect). During a concurrent observation and interview on 1/4/2024 at 9:54 am, with Infection Prevention Nurse (IPN), the IPN stated foley catheter tubing should not be touching the floor because the floor (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 26 of 27 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 055187 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/05/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Garden View Post Acute Rehabilitation 14475 Garden View Lane Baldwin Park, CA 91706 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 was dirty. Level of Harm - Minimal harm or potential for actual harm During an interview on 1/4/2024 at 11:22 am, with the facility's Director of Nursing (DON), the DON stated the foley catheter bag and tubing should be off the floor for this could lead to urinary tract infection. Residents Affected - Some During a review of the facility's P&P titled, Indwelling Urinary Catheter Care, revised on 1/2023, the P&P indicated, to promote hygiene, comfort, and decrease the risk of infection for a resident with an indwelling urinary catheter. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055187 If continuation sheet Page 27 of 27