Health inspection·January 23, 2026

F 0550 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to maintain ethical standards of practice (guidelines that govern behavior and prioritize resident dignity, autonomy [independence], safety, and guided by principles of beneficence [acting in the patient's best interest], non-maleficence [do no harm], justice, and respect for rights) for one of two sampled residents (Resident 2) by purchasing a prescribed Brand 1 sensor (a small, wearable continuous blood glucose [sugar] monitor sensor that measures blood glucose levels in real-time beneath the skin) from Resident 1 on 10/13/2025. This failure resulted in the facility completing an inappropriate business transaction with Resident 1, whom they provide all care and services for, with the potential to negatively impact Resident 1's psychosocial (the interaction between an individual's mental processes [thoughts, emotions & behaviors] and their social environment [relationships, culture & community] wellbeing.Findings:During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was initially admitted to the facility on [DATE] with diagnoses that included type 2 diabetes mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing), hypertensive heart disease (heart complications caused by high blood pressure that is present over a long time) with heart failure (a chronic condition in which the heart does not provide adequate blood flow to meet the body's needs) and difficulty in walking. During a review of Resident 1's Minimum Data Set (MDS- a resident assessment tool), dated 10/31/2025, the MDS indicated Resident 1 had intake cognitive skills for daily decision making. The MDS also indicated Resident 1 was independent (resident completes the activity by themselves with no assistance from a helper) with eating, dressing, personal, oral and toileting hygiene and partial/moderate assistance (helper does less than half the effort) with shower/bathing self. During a review of Resident 1's Order Listing Report, dated 11/26/2025, the Order Listing Report indicated (nursing) may monitor blood sugar levels by Brand 1 before (AC) meals. During a review of an untitled facility document, dated 10/13/2025, the document indicated Resident 1 had three (3) Brand 1 devices and the facility will purchase one (1) (from Resident) for education/training purposes only for $110. The document was signed by the Director of Nursing (DON), Resident 1 and Licensed Vocational Nurse 1 (LVN 1). During a review of the facility's Petty Cash Receipt, dated 10/13/2025, the receipt indicated the facility staff paid Resident 1 $110 for a Brand 1 device. During an interview on 1/23/2026 at 9:36 AM with the Director of Nursing (DON), the DON stated Resident 1 offered (unable to recall when) the facility the opportunity to purchase a Brand 1 device from Resident 1 for training purposes, so she (the DON) agreed to purchase the Brand 1 device from Resident 1 with the facility's money. During a concurrent interview and record review on 1/23/2026 at 9:46 AM with the DON, the facility's How to Apply Brand 1 Sensor lesson plan outline, dated 10/15/2025, the lesson plan outline indicated the method of training as lecture, video and demonstration. The DON stated she taught the class and used the purchased Brand 1 device from Resident 1 for the staff to complete (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 055203 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 055203 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/23/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Sunny Village Care Center 1428 S. Marengo Ave. Alhambra, CA 91803 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)