Health inspection·April 16, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Review of the facility's Grievance/ Complaint Report Form dated 4/5/25, showed CNA 3 came to Resident 1's room while she was on her phone. CNA 3 sat next to Resident 1 and put his hand on her shoulder (brushing), making Resident 1 feeluncomfortable. On 4/10/25 at 1000 hours, an interview was conducted with Resident 1. Resident 1 stated the alleged abuse incident with CNA 3 occurred on 4/4/25. Resident 1 stated while she was playing a game on her phone, CNA 3 sat on her bed and put his arms around her. Resident 1 gestured towards her shoulder and touched her thigh. Resident 1 further stated she felt uncomfortable and violated. Resident 1 stated she reported the incident to RN 2. On 4/10/25 at 1240 hours, an interview was conducted with RN 2. RN 2 verified the alleged abuse incident occurred on 4/4/25, and stated the DON, SSD, and Administrator were informed. On 4/10/25 at 1355 hours, an interview was conducted with the SSD. The SSD stated she was informed of the alleged abuse incident on 4/4/25, and received the grievance on 4/7/25. On 4/10/25 at 1430 hours, an interview was conducted with the DON. The DON stated the alleged abuse was reported to her on 4/4/25,and the grievance report was filed by RN 2. The DON further stated she would submit the SOC. On 4/11/25 at 1029 hours, an interview was conducted with the Administrator. The Administrator was informed and acknowledged the above findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055330 If continuation sheet Page 2 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehab Center of Tustin 2210 E. First Street Santa Ana, CA 92705 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 0660 Plan the resident's discharge to meet the resident's goals and needs. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, and facility P&P review, the facility failed to ensure the necessary care and services were coordinated to meet the resident's needs when discharged from the facility for one of two sampled residents (Resident 4). This failure resulted in Resident 4 not having appropriate care at home, which had the potential to negatively affect Resident 1's health. Residents Affected - Few Findings: Closed medical record review for Resident 4 was initiated on 4/10/25. Resident was admitted in the facility on 1/2/25 and was discharged on 3/17/25. Review of Resident 4's H&P examination showed the resident had fluctuating capacity to understand and make decisions. Review of Resident 4's MDS assessment dated [DATE], showed the resident had a BIMS score of 6, indicating severe cognitive impairment. Resident 4's functional abilities showed the resident required substantial to maximal assistance in eating, oral hygiene and upper body dressing. Resident 4 was dependent with toileting, lower body dressing, transfers from chair/bed to chair, and did not attempt to walk due to medical condition. Review of Resident 4's Discharge Summary/ Post Discharge Plan of Care with an effective date of 3/12/25, failed to show the review of the discharge plan was signed and dated by the resident/resident representative under section F. Review of Resident 4's Order Summary Report showed a physician's order dated 3/17/25, for may discharge home on 3/17/25 with medications, home health, physical/occupational therapy evaluation, registered nurse for medication management, and medical equipment bed and wheelchair. Further review of Resident 4's medical record failed to show documented evidence of a family member education for Resident 4's care at home. On 4/11/25 at 1115 hours, a telephone interview was conducted with Family Member 1. Family Member 1 stated he informed the facility he would not be able to be at Resident 4's home during the time of discharge, however the facility proceeded to discharge the resident to the home and was received by her roommate. Family Member 1 stated he did not receive any discharge education or instructions for Resident 4's care at home. Family Member 1 further stated the SSD told him the home health agency would visit the resident to provide care. However, the home health agency required Family Member 1 to take Resident 4 to the physician's office to get approved for home health visits. Family Member 1 stated he could not transport Resident 4 to the physician's office because Resident 4 had limited mobility, and he did not know how to transfer the resident to his car. Family Member 1 further stated Resident 4 was helpless, in pain and not eating, Resident 4 felt depressed at home. Resident 4 was taken to the acute care hospital via paramedics. On 4/15/25 at 1426 hours, an interview and concurrent medical record review was conducted with RN 3. RN 3 stated the SSD made arrangements for the resident's discharge transportation and home health agency to follow up. RN 3 stated she did not remember providing education on the home care to the resident's family member. RN 3 verified Resident 4's Discharge Summary/ Post Discharge Plan of Care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055330 If continuation sheet Page 3 of 4 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 055330 B. Wing A. Building (X3) DATE SURVEY COMPLETED 04/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Advanced Rehab Center of Tustin 2210 E. First Street Santa Ana, CA 92705 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 0660 was not signed by the resident/resident's representative. Level of Harm - Minimal harm or potential for actual harm On 4/15/25 at 1501 hours, an interview and concurrent medicalrecord review was conducted with the DON. The DON verified Resident 4's Discharge Summary/ Post Discharge Plan of Care was notsigned by the resident/resident'srepresentative. The DON further stated she expected the nurses to educate the resident or resident's representative on the plan of care for discharge. Residents Affected - Few On 4/15/25 at 1640 hours, an interview and concurrent medical record review was conducted with the SSD. The SSD stated a referral for the home health care was sent to the home health agency with an understanding the home health agency accepted the resident. However, the SSD received an email from the home health liaison officer stating the home health agency required an approval from Resident 4's primary physician. The SSD further stated the resident's family member could not take the resident to see the resident's physician which caused the resident not to receive the home health care services as ordered by the facility's physician for the discharge. On 4/16/25 at 0947 hours, an interview was conducted with the DOR. The DOR stated the resident was totally dependent with bed mobility and was transferred from bed to wheelchair using a Hoyer lift. Resident 4 was unable to stand and could not walk. The resident was discharged from the rehabilitation services on 3/3/25 to receive the RNA services for the range of motion exercises. The DOR verified no family teaching was provided because the resident was discharge to RNA. On 4/16/25 at 1008 hours, an interview was conducted with the MDS Nurse. The MDS Nurse stated the resident had fluctuating cognitive capacity. The MDS Nurse stated the SSD was responsible to coordinate discharge with the resident's family member. The MDS Nurse stated he did not provide a family education for care of Resident 4 at home. On 4/16/25 at 1101 hours, an interview was conducted with the home health agency liaison officer. The home health agency liaison officer stated the resident was eligible for home health however, the family member was not able to transport Resident 4 to the resident's primary physician to get approval for the home health services. The home health agency liaison officer verified Resident 4 did not receive any home health care from the agency. On 4/16/25 at 1645 hours, an interview was conducted with the Administrator. The Administrator was informed and acknowledged the findings above. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055330 If continuation sheet Page 4 of 4