Health inspection·December 17, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to notify the physician when the following medications: methimazole (used to treat hyperthyroidism [a condition that a thyroid gland produces and releases too much thyroid hormone], albuterol sulfate (used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases), and ipratropium bromide (a medication that helps breathe easier) were unavailable for administration to one for four sampled residents (Resident 1). This deficient practice resulted in Resident 1's physician being unaware Resident 1's medications were not available for administration and placed the resident at risk for health complications. Findings:During a review of Resident 1's admission Record, the admission Record indicated the facility admitted Resident 1 on 12/12/2025 with diagnoses including left and right pubis (one of the three main bones that make up the pelvis, a structure located between the abdomen and thighs) fractures (broken bone), sacrum (a large, triangular bone at the base of the backbone) fracture, the fourth lumbar vertebra vertebra (five large bones in your lower back) fracture, acute respiratory failure (ARF - a serious condition that makes it difficult to breathe on your own) with hypoxia (a severe deficiency of oxygen in the blood and tissues), and anxiety disorder (a mental health condition where you experience excessive, persistent worry, fear, or nervousness that does not go away and interferes with daily life, causing physical symptoms). During a review of Resident 1's History and Physical (H&P) Examination dated 12/13/2025, the H&P Examination indicated Resident 1 did not have the capacity to understand and make decisions. During a review of Resident 1's Order Summary Report dated 12/17/2025, the Order Summary Report indicated the following orders with order and start date of 12/12/2025: -Admit Resident 1 to the facility for skilled nursing and therapy -Methimazole oral tablet five (5) milligrams (mg - a unit of measurement) to give one (1) tablet by mouth every eight (8) hours for hyperthyroidism. -Albuterol sulfate inhalation (the act of breathing in air through nose or mouth, drawing it down into the lungs) nebulization (a device turns liquid medicine into a super-fine mist that you breathe in through a mask or mouthpiece, delivering medicine directly to your airways) solution 2.5 mg/0.5 milliliter (ml - a unit of measurement), or Albuterol Sulfate, 0.5 ml inhale orally via nebulizer every four (4) hours for short of breath/wheezing (a high-pitched sound made when breathing is restricted/obstructed in the lungs). -Ipratropium bromide inhalation solution 0.02 percent (% - a unit of measurement), or Ipratropium Bromide, 2.5 ml inhale orally every four (4) hours for short of breath/wheezing. During a review of Resident 1's Medication Administration Records (MAR - a daily documentation record used by a licensed nurse to document medications given to a resident) for 12/2025, the MAR indicated that Licensed Vocational Nurse 1 (LVN 1) documented code number nine (9 - other/see nurses notes per the chart codes) on 12/12/2025 for the following medications:1. Methimazole oral tablet five (5) mg scheduled for 9 p.m.2. Albuterol Sulfate 0.5 ml inhale orally via nebulizer scheduled at 8 p.m.3. Ipratropium Bromide, 2.5 ml inhale Page 1 of 2 055443 055443 12/17/2025 West Valley Post Acute 7057 Shoup Ave West Hills, CA 91307

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few orally scheduled at 8 p.m. During a review of Resident 1's Medication Administration Notes (MAN) dated 12/12/2025 and documented by LVN 1, the MAN indicated the following notes:1. Timed at 9:07 p.m., Albuterol Sulfate 0.5 ml inhale orally via nebulizer; new admit, followed up with pharmacy.2. Timed at 9:08 p.m., Methimazole oral tablet five (5) mg; new admit, followed up with pharmacy.3. Timed at 9:08 p.m., Ipratropium Bromide, 2.5 ml inhale orally; new admit, followed up with pharmacy. During a concurrent telephone interview and record review on 12/17/2025 at 1:51 p.m., with LVN 1, reviewed Resident 1's MAR for 12/2025. LVN 1 stated Resident 1 was admitted on [DATE] and the following medications: Methimazole oral tablet five (5) mg scheduled for 9 p.m., on 12/12/2025, Albuterol Sulfate 0.5 ml inhale orally via nebulizer scheduled on 12/12/2025 at 8 p.m., and Ipratropium Bromide, 2.5 ml inhale orally scheduled 12/12/2025 at 8 p.m., were not available for administration to Resident 1. LVN 1 stated that he reported the unavailability of Resident 1's medications to the Registered Nurse (RN) supervisors and received instructions to contact the pharmacy and to document in Resident 1's medical record. LVN 1 stated that the pharmacy notified him that Resident 1's medications would be delivered on the following day (12/13/2025). LVN 1 stated he did not notify Resident 1's physician that Resident 1's medications were not available for administration on 12/12/2025 because he did not receive instructions from the RN Supervisors to do so. During a concurrent interview and record review on 12/17/2025 at 2:33 p.m., with RN 1, RN 1 reviewed Resident 1's MAR for 12/2025. RN 1 stated the MAR indicated that LVN 1documented an entry of number 9 for the following medications: Methimazole oral tablet five (5) mg scheduled for 9 p.m., on 12/12/2025, Albuterol Sulfate 0.5 ml inhale orally via nebulizer scheduled on 12/12/2025 at 8 p.m., and Ipratropium Bromide, 2.5 ml inhale orally scheduled 12/12/2025 at 8 p.m. RN 1 stated there was no documented evidence that licensed nurses notified Resident 1's physician that the medications above were unavailable for administration as ordered to Resident 1. During an interview with the Assistant Director of Nursing (ADON) on 12/12/2025 at 3:13 p.m., the ADON stated that licensed nurses should have notified Resident 1's physician that Resident 1's medications were unavailable on admission so the physician could have determined an alternative plan to address the unavailability of Resident 1's medications. During a review of the facility's policy and procedure (P&P) titled, Change in a Resident's Condition or Status, last reviewed 5/28/2025, the P&P indicated, Our facility promptly notifies the resident, his or her attending physician, and the resident representative of changes in the resident's medical/mental condition and/or status. Except in medical emergencies, notifications will be made within twenty-four (24) hours of a change occurring in the resident's medical/mental condition or status. During a review of the facility's P&P titled, Prescriber Medication Orders, last reviewed 5/28/2025, the P&P indicated, The prescriber is contacted for direction when delivery of a medication will be delayed or the medication is not or will not be available. 055443 Page 2 of 2