Health inspection·December 19, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a review of Resident 2's admission Record, the admission Record indicated the facility admitted Resident 2 on 7/30/2019, with diagnoses that included metabolic encephalopathy (not a primary brain injury but a secondary effect, leading to confusion, memory issues, personality changes), diabetes mellitus (DM- a disorder characterized by difficulty in blood sugar control and poor wound healing) and generalized muscle weakness.During a review of Resident 2's H&P, dated 9/15/2025, the H&P indicated Resident 2 did not have the capacity to understand and make decisions.During a review of Resident 2's MDS, dated [DATE], the MDS indicated Resident 2's cognitive skills for daily decisions were severely impaired.During a review of Resident 2's SBAR Communication Form, dated 12/9/2205, the SBAR indicated Resident 2 while being wheeled on the hallway without warning, reached over Resident 1's and hit Resident 1 on the left side of the face as they passed each other.During a review of Resident 2's Psychological Consultation dated 12/12/2025, the Psychological Consultation indicated Resident 2 was involved in a recent incident in which a nursing staff member (CNA 1) observed Resident 2 strike Resident 1 for no apparent reason.During a review of Certified Nursing Assistant 2 (CNA 2) Investigation Statement, dated 12/9/2025, the Investigation Statement indicated CNA 2 followed CNA 1 walking in the hallway pushing Resident 2's wheelchair when Resident 2 grabbed Resident 1's left arm and hit or punched Resident 1's face.During an interview on 12/18/2025, at 9:24 a.m., with Licensed Vocational Nurse 1 (LVN 1), LVN 1 stated she (LVN 1) was at the nursing station when she (LVN1) heard screams from the hallway. LVN 1 stated when she (LVN 1) responded, CNA 1 reported that Resident 2 slapped Resident 1 on the left face by the cheek. LVN 1 stated when she (LVN 1) had asked Resident 1, Resident 1 confirmed that she (Resident 1) was hit on the left cheek. LVN 1 stated Resident 2 had aggressive behavior at times and Resident 2 was monitored for aggressive behavior towards the staff.During an interview on 12/18/2025, at 9:35 a.m., with Registered Nurse 1 (RN 1), RN 1 stated on 12/9/2025, LVN 1 called for her (RN 1) into the hallway and when she (RN 1) responded she (RN 1) saw Resident 1 seated on a wheelchair on the hallway and Resident 2 was not around. RN 1 stated she (RN 1) had asked Resident 1 of what happened and Resident 1 reported that Resident 2 grabbed her (Resident 1) left arm and Resident 2 hit Resident 1 on the left face on her (Resident 1) cheek. RN 1 stated CNA 1 witnessed the incident. RN 1 stated Resident 2 had a behavior towards the staff as Resident 2 had once pulled his (Resident 2) intravenous (IV-delivering fluids, nutrients, or medicine directly into a vein) line before and threw it at her (RN 1). RN 1 stated the incident was an abuse because Resident 2 hit Resident 1.During an interview on 12/18/2025, at 10:22 a.m., with the Director of Nursing (DON), the DON stated LVN 1 reported that CNA 1 was wheeling Resident 2 in the hallway when they (CNA 1 and Resident 2) came across Resident 1 and Resident 2 reached over and hit Resident 1 on the left face by the cheek. The DON stated she (DON) also asked CNA 1 and CNA 1 also said the same thing happened.During an interview on 12/19/2025, at 8:20 a.m., with CNA 2, CNA 2 stated on 12/9/2025, he (CNA 2) was walking behind CNA 1 while CNA 1 was pushing Resident 2 on a wheelchair when they came across Resident 1 in front of room A. CNA 2 stated CNA 1 was wheeling Resident 2 on the right side of the hallway and Resident 1 was wheeling herself on the left side of the hallway. CNA 2 stated he (CNA 2) witnessed Resident 2 used his (Resident 2) left hand grabbed Resident 1's left arm and Resident 2 with his (Resident 2) right hand closed his (Resident 2) fist and punched Resident 1 on the left face by the cheek. CNA 2 stated Resident 2's hand touched Resident 1's left cheek then his (Resident 2) fist slid down Resident 1's left cheek. CNA 2 stated Resident 2 attempted to do it again, but he (CNA 2) had held Resident 2's hands to stop him (Resident 2). CNA 2 stated Resident 2 had aggressive behavior of throwing the tray and pushing the table.During an interview on 12/19/2025, at 8:28 a.m. with CNA 1, CNA 1 stated on 12/9/2025, she (CNA 1) was taking Resident 2 while seated on a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055287 If continuation sheet Page 2 of 6 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 055287 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few wheelchair to the activity room when they came across Resident 1 in the hallway. CNA 1 stated Resident 2 used his (Resident 2) left hand grabbed Resident 1's left wheelchair armrest, Resident 2 made a fist with his (Resident 2) right hand and punched Resident 1 on the left cheek. CNA 1 stated she (CNA 1) saw Resident 2 about to hit Resident 1, so she (CNA 1) pulled back Resident 2's wheelchair but Resident 2's fist already made contact with Resident 1's left cheek. CNA 1 stated Resident 2 punched Resident 1 so that was an abuse.During an interview on 12/19/2025, at 9:09 a.m., with the Assistant Director of Nursing (ADON), the ADON stated there was evidence that the incident between Resident 1 and Resident 2 was substantiated (a claim or assertion that is supported by adequate proof or evidence). ADON stated the incident was witnessed and Resident 1 reported that she (Resident 1) was hit.During a concurrent interview, and record review on 12/19/2025, at 9:31 a.m., with the DON, facility's policy and procedure (P&P), titled Abuse, Neglect (fail to care for properly), Exploitation (the action or fact of treating someone unfairly in order to benefit from their work) and Misappropriation (the unauthorized use of another's name, property without that person's permission) Prevention Program, dated 4/2021, and last reviewed on 1/28/2025, the P&P indicated, Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. The resident abuse, neglect and exploitation prevention program consists of a facility-wide commitment and resource allocation to support the following objectives: 1. Protect residents from abuse, neglect, exploitation or misappropriation of property by anyone including, but not necessarily limited to: . b. other residents. The DON stated the facility's P&P indicated that residents have the right to be free from abuse. The DON stated Resident 1 was physically affected when she (Resident 1) was hit by Resident 2.During an interview on 12/19/2025, at 9:42 a.m., with the Director of Staff Development Assistant (DSDA), the DSDA stated abuse definition is any unwanted touch from another person without permission. The DSDA stated the incident between Resident 1 and Resident 2 was an abuse because it was something not warranted by the other individual. The DSDA stated Resident 1 was hit and that it was unwarranted and not something she (Resident 1) wanted, so it was considered an abuse.During an interview on 12/19/2025, at 9:45 a.m., with the Social Service Director (SSD), the SSD stated Resident 1 was a victim of being hit by Resident 2.During an interview on 12/19/2025, at 9:59 a.m., with the Administrator (ADM), the ADM stated the incident between Resident 1 and Resident 2 was not an abuse because there were no resulting injuries and Resident 2 was confused and acted without malice due to his (Resident 2) impaired cognition. The ADM stated there was physical contact when Resident 2's fist only grazed (light contact) Resident 1's left cheek.During an interview on 12/19/2025, at 10:30 a.m., with the DON, the DON stated Resident 2 hit Resident 1's left cheek. The DON stated even if it was just a grazed but because Resident 2's fist landed on Resident 1's left cheek, there was physical contact. The DON stated the facility's P&P indicated resident have the right to be free from abuse and since Resident 2 hit Resident 1, Resident 1 was not free from abuse because she (Resident 1) was hit.During a review of facility's P&P, titled Identifying Types of Abuse, dated 9/2022, and last reviewed on 1/28/2025, the P&P indicated, As part of the abuse prevention strategy, volunteers, employees and contractors hired by this facility are expected to be able to identify the different types of abuse that may occur against residents. 1.Physical abuse includes, but is not limited to hitting, slapping, biting, punching or kicking Psychosocial (relating to the interrelation of social factors and individual thought and behavior) OutcomesSome situations of abuse do not result in an observable physical injury, or the psychosocial effects of abuse may not be immediately apparent. In addition, the alleged victim may not report abuse due to shame, fear, or retaliation. Other residents may not be able to speak due to medical condition and/or cognitive impairment, cannot recall what has (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055287 If continuation sheet Page 3 of 6 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 055287 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete occurred, or may not express outward signs of physical harm, pain, or mental anguish. Neither physical marks on the body nor the ability to respond and/or verbalize is needed to conclude that abuse has occurred.During a review of facility's P&P, titled, Recognizing Signs and Symptoms of Abuse/Neglect, dated 4/2021 and last reviewed on 1/28/2025, the P&P indicated, Abuse is defined as willful (means an act was done deliberately, intentionally, and consciously, showing a purpose or willingness to do the act, rather than by accident or negligence, though it doesn't always require evil intent) infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. Event ID: Facility ID: 055287 If continuation sheet Page 4 of 6 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 055287 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605 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 0697 Provide safe, appropriate pain management for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to ensure one of four sampled residents (Resident 3) was medicated for pain as per physician's order.This deficient practice had the potential to result in Resident 3's uncontrolled pain. Findings:During a review of Resident 3‘s admission Record, the admission Record indicated the facility admitted Resident 3 on 8/5/2025, with diagnoses that included multiple fracture (bone breaks) of the ribs, fall, and hypertensive heart disease (heart has been damaged or overworked because of long-term, uncontrolled high blood pressure, making it harder to pump blood, leading to issues like a thickened heart muscle) with heart failure (heart is not pumping blood as well as it should).During a review of Resident 3's Order Summary Report, dated 12/4/2025, the Order Summary Report indicated hydrocodone-acetaminophen (medication used to treat pain) oral tablet 5-325 milligram (mg- metric unit of measurement, used for medication dosage and/or amount), give one tablet by mouth every four hours as needed for moderate to severe pain level of four to ten (a 1-10 pain scale is a common tool where 0 means no pain and 10 is the worst pain imaginable, used to rate intensity).During a review of Resident 3's Minimum Data Set (MDS-a resident assessment tool), dated 12/9/2025, the MDS indicated Resident 3's cognitive (mental action or process of acquiring knowledge and understanding) skills for daily decisions were intact. The MDS indicated Resident 3 had occasional pain level of six out of ten.During a review of Resident 3's Medication Administration Record (MAR- flowsheet that indicates medications given to a resident), dated 12/2025, the MAR indicated on 12/5/2025, Resident 3 had a pain level of eight out of ten.During an interview on 12/18/2025, at 8:59 a.m., with Resident 3 stated she (Resident 3) had left ribs fracture and was in too much pain. Resident 3 stated when nurses move and turn her (Resident 3) she (Resident 3) would scream. Resident 3 stated she (Resident 3) when she (Resident 3) receives pain medication, it helps but only for a short time.During a concurrent interview, and record review on 12/19/2025, at 9:09 a.m., with the Assistant Director of Nursing (ADON), Resident 3's Order Summary Report, dated 12/4/2025, MAR, dated 12/2025, and Progress Notes, dated 12/5/2025, were reviewed. The ADON stated there was no documentation in Resident 3's Progress Notes if pain medication was administered on 12/5/2025. The ADON stated Licensed Vocational Nurse 3 (LVN 3) documented that Resident 3 had a pain level of eight out of ten on 12/5/2025, and the MAR did not indicate hydrocodone was given. The ADON stated LVN 3 should have administered hydrocodone to Resident 3's pain as ordered by the physician. The ADON stated Resident 3 could have suffered in pain that could have resulted in uncontrollable pain.During an interview on 12/19/2025, at 9:31 a.m., with the Director of Nursing (DON), the DON stated nurse should medicate Resident 3 for pain as ordered by the physician. The DON stated Resident 3 could have unresolved pain that could affect Resident 3's mood and could cause Resident 3's distress.During a review of facility's policy and procedure (P&P) titled, Pain-Clinical Protocol, dated 10/2022, and last reviewed on 1/28/2025, the P&P indicated, 2. The physician will order appropriate non-pharmacologic (means without using medicine or drugs) and medication interventions to address the individual's pain.During a review of facility's P&P, titled, Administering Medications, dated 4/2019, and last reviewed on 1/28/2025, the P&P indicated, Medications are administered in accordance with prescriber orders, including any required time frame. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055287 If continuation sheet Page 5 of 6 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 055287 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/19/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Valley Palms Care Center 13400 Sherman Way N Hollywood, CA 91605 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on interview and record review, the facility failed to follow the physician's order for one of three sampled residents (Resident 3) when Licensed Vocational Nurse 2 (LVN 2) administered sacubitril-valsartan (medication used to treat heart failure [heart was not pumping blood as well as it should to meet the body's needs]) to Resident 3 who had a blood pressure of 109/77 millimeter of mercury (mmHg-unit for measuring pressure) despite a physician's order to hold (suspend the medication) the sacubitril-valsartan for blood pressure below 110 mmHg.This failure had the potential to result in Resident 3's hypotension (low blood pressure). Findings:During a review of Resident 3‘s admission Record, the admission Record indicated the facility admitted Resident 3 on 8/5/2025, with diagnoses that included multiple fracture (bone breaks) of the ribs, fall and hypertensive heart disease (heart has been damaged or overworked because of long-term, uncontrolled high blood pressure, making it harder to pump blood, leading to issues like a thickened heart muscle) with heart failure (heart is not pumping blood as well as it should) During a review of Resident 3's Order Summary Report, dated 12/4/2025, the Order Summary Report indicated sacubitril-valsartan 24-26 milligram (mg- metric unit of measurement, used for medication dosage and/or amount), give one tablet by mouth two times a day for congestive heart failure (CHF- a heart disorder which causes the heart to not pump the blood efficiently, sometimes resulting in leg swelling), hold for systolic blood pressure (sbp- pressure in the arteries when the heart beats) less than 110 mmHg or for heart rate less than 60 beats per minute (bpm).During a review of Resident 3's Minimum Data Set (MDS-a resident assessment tool), dated 12/9/2025, the MDS indicated Resident 3's cognitive (mental action or process of acquiring knowledge and understanding) skills for daily decisions were intact.During a review of Resident 3's Medication Administration Record (MAR- flowsheet that indicates medications given to a resident), dated 12/2025, the MAR indicated on 12/16/2025, at 5 p.m. Resident 3's blood pressure was 109/77 mmHg and Licensed Vocational Nurse 2 (LVN2) administered sacubitril-valsartan to Resident 3.During a review of Resident 3's Progress Notes, dated 12/16/2025, timed at 6:25 p.m., the Progress Notes indicated LVN 2 documented that all due medication was given.During a concurrent interview, and record review on 12/19/2025, at 9:09 a.m., with the Assistant Director of Nursing (ADON), Resident 3's Order Summary Report, dated 12/4/2025, MAR, and Progress Notes, dated 12/16/2025, were reviewed. The ADON stated check marked on the MAR indicated medication was given. The ADON stated LVN 2 should have held the sacubitril-valsartan on 12/16/2025, at 5 p.m. following the physician order to hold the medication for sbp below 110 mmHg because Resident 3's blood pressure was 109/77 mmHg. The ADON stated Resident 3 could experience hypotension and can get dizzy.During an interview on 12/19/2025, at 9:31 a.m., with the Director of Nursing (DON), the DON stated LVN 2 should follow the physician's order to hold the medication if sbp was below 110 mmHg to prevent Resident 3 from developing any adverse reaction (any unwanted, unexpected, or harmful physical effect caused by a medication) like hypotension.During a review of facility's policy and procedure (P&P), titled, Administering Medications, dated 4/2019, and last reviewed on 1/28/2025, the P&P indicated, Medications are administered in a safe and timely manner, and as prescribed.4. Medications are administered in accordance with prescriber orders, including any required time frame.11. The following information is checked/verified for each resident prior to administering medications: a. Allergies to medications; and b. Vital signs (body's most basic checks on how well it's working, reflecting its essential functions like breathing, heart rate, temperature, and blood pressure), if necessary. Event ID: Facility ID: 055287 If continuation sheet Page 6 of 6