Health inspection·December 2, 2025

F 0552 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete RP consents to the vaccinations then the vaccines are given, documented in the point click care (PCC -a charting system used in nursing homes, assisted living and home care) under immunizations, an order is entered in the residents orders, then onto the electronic medication administration record (EMAR - a digital system that replaces paper-based charts for tracking how and when medications are given to patients) of the residents for the nurses to monitor the resident for adverse effects for 72 hours. A review of the facility's P&P titled, Coronavirus Vaccine Policy (COVID-19 Vaccine Policy) reviewed on 7/11/2025, indicated under documentation that, Documenting COVID-19 Vaccine:The facility will maintain documentation for all residents and staff on COVID-19 vaccination status, For . residents, the information will be documented in their medical record.The information to be documented includes:The staff person, resident or representative was provided education regarding the benefits and potential risks associated with COVID-19 vaccine.Whether the . resident/representative consented to the vaccine. If yes:Which vaccine was administered?Which dose was administered?Date of vaccinationAny Signs/Symptoms of adverse reaction.If no, reason for refusal:ContraindicationRefusalFor staff or residents who refuse, the facility will ask the individual to signCOVID-19 vaccine declination form and maintain a copy of the form. Event ID: Facility ID: 055473 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 055473 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Vista Post-Acute Care Center 1516 Sawtelle Blvd. Los Angeles, CA 90025 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 observations, interviews and record review, facility failed to ensure staff adhered to infection control practices by failing to:1. Ensure four of five sampled residents (Residents 5, 6, 7, and 8) received Coronavirus disease 2019 (COVID-19 - an illness caused by a virus which causes severe acute respiratory syndrome), pneumonia (an infection in one or both lungs that may be caused by bacteria, viruses, or fungi) and influenza (an infection of the nose, throat and lungs, which are part of the respiratory system) vaccines2. Ensure certified nursing assistant (CNA) 1, CNA 2, and licensed vocational nurse (LVN) 1 were fit tested (confirm that a respirator forms a tight seal to your face before you use it in the workplace) for N95 mask (a personal protective equipment [PPE] used to protect the wearer from particles or from liquid contaminating the face) according to the facility P&P titled, Fit Test and Respirator Seal Check Policy reviewed [DATE].3. Ensure facility staff performed hand hygiene and donned (put on, applied) appropriate PPE before entering a covid isolation room.4. High touch surface areas (surfaces that frequently come in contact with humans) were disinfected according to the facility document titled, Corona Virus Disease 2019 (COVID -19) Mitigation Plan reviewed [DATE]. Staff appropriately handled contaminated/dirty linen from a covid isolation room according to the facility P&P titled, Infection Control Policy -Laundry Services reviewed [DATE], and P&P titled, Infection Control Program System reviewed [DATE] These deficient practices placed the residents and staff at increased risk to contract covid-19, hospitalization and/or death.Findings A review of Resident 5's admission Record indicated Resident 5 was admitted to the facility on [DATE] and was readmitted to the facility on [DATE] with diagnoses that included liver transplant (a surgery that removes a liver that no longer functions properly [liver failure] and replaces it with a healthy liver from a deceased donor or a portion of a healthy liver from a living donor), diabetes mellitus (DM - a disorder characterized by difficulty in blood sugar control and poor wound healing), and end stage renal disease (ESRD -irreversible kidney failure). A review of Resident 5's Minimum Data Set (MDS - a resident assessment tool) dated [DATE], indicated Resident 5 had intact cognition (when a person has no trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life), needed set up/clean up assistance with eating, partial/moderate assistance with oral hygiene, and required substantial/maximal assistance from staff with all other activities of daily living (ADL - activities such as bathing, dressing and toileting a person performs daily). A review of Resident 5's influenza immunization informed consent dated [DATE] indicated that Resident 5 gave a verbal consent for the facility to administer the influenza vaccination. A review of Resident 5's COVID 19 immunization informed consent 2025-2026 dated [DATE] indicated that Resident 5 gave a verbal consent for the facility to administer the COVID 19 vaccination. A review of Resident 6's admission Record indicated that resident 6 was admitted to the facility on [DATE] and was readmitted to the facility on [DATE] with diagnoses that included hyperlipidemia (too many lipids [fats] in the blood), dysphagia (difficulty swallowing), and diabetes mellitus (DM - a disorder characterized by difficulty in blood sugar control and poor wound healing). A review of Resident 6's MDS dated [DATE], indicated Resident 6 had intact cognition, was independent with eating, required set up/clean up assistance from staff with oral hygiene, and required staff assistance with ADL (bathing, dressing and toileting a person performs daily). A review of Resident 6's influenza immunization informed consent dated [DATE] indicated Resident 6 gave a verbal consent for the facility to administer the influenza vaccination. A review of Resident 6's COVID 19 immunization informed consent 2025-2026 dated [DATE] indicated Resident 6 gave a verbal consent for the facility to administer the COVID 19 vaccination. A review of Resident 7's admission Record Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055473 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 055473 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Vista Post-Acute Care Center 1516 Sawtelle Blvd. Los Angeles, CA 90025 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 - Few indicated that Resident 7 was admitted to the facility on [DATE] with diagnoses that included hyperlipidemia (elevated lipids [fats] in the blood), dysphagia (difficulty swallowing), and, and hypertension (HTN - high blood pressure). A review of Resident 7's MDS dated [DATE], indicated Resident 7 had impaired cognition (when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life), was dependent on staff with ADL (bathing, dressing and toileting a person performs daily). A review of Resident 8's admission Record indicated that Resident 8 was admitted to the facility on [DATE] and was readmitted to the facility on [DATE] with diagnoses that included schizophrenia (a serious mental illness that is characterized by disturbances in thought), hyperlipidemia, and HTN. A review of Resident 8's history and physical (H&P - formal and complete assessment of the patient and the problem) date [DATE] indicated that Resident 8 did not have the capacity for medical decision due to mental incapacitation (the physical and/or mental inability to make informed, rational judgments and decisions) and mental disorder (conditions that affect your thinking, feeling, mood, and behavior). A review of Resident 8's MDS dated [DATE], indicated Resident 8 had impaired cognition, was independent with eating, oral hygiene, and required substantial/maximal assistance from staff with ADL (bathing, dressing and toileting a person performs daily). A review of Resident 8's influenza immunization informed consent dated [DATE] indicated that Resident 8 gave a verbal declination consent for the facility to administer the influenza vaccination. A review of Resident 8's COVID 19 immunization informed consent 2025-2026 dated [DATE] indicated that Resident 8 gave a verbal declination consent for the facility to administer the COVID 19 vaccination. During a concurrent observation and concurrent interview on [DATE], at 9:03 A.M., Certified Nursing Assistant (CNA) 1 entered a covid isolation room without performing hand hygiene and did not wear appropriate PPE for the room. CNA 1 was observed wearing N95 mask. CNA 1 was also observed coming out of the covid isolation room into the hallway holding contaminated/dirty linen. CNA 1 stated that before entering any resident room, he is supposed to perform hand hygiene using alcohol-based hand rub (ABHR - kill microorganisms [a living thing that is so small it must be viewed with a microscope] on hands that cause infection) located outside the isolation room the door. CNA 1 stated he did not perform hand hygiene before entering the isolation room. CNA 1 stated for the covid isolation room, in addition to wearing N95 mask, he (CNA 1) he is supposed to put on a gown, and gloves which were inside the isolation cart located by the covid isolation room. CNA 1 stated PPE are put on before entering the covid isolation room for infection control so that he does not get covid. CNA 1 also stated that dirty linen from the covid isolation room should be placed in the dirty linen hamper in the covid isolation room and not be brought out into the hallways because of infection control. During an interview on [DATE], at 12:16 P.M., the Janitor (JT) stated that it is the responsibility of the JT to disinfect the high touch surface areas (handrails in the hallway). JT stated that he disinfects the handrails in the hallway twice during his shift, at 5 A.M., and at 1 P.M. JT stated that the handrails in the hallway are disinfected to prevent infection. JT stated that once the handrails in the hallway are disinfected, there is no documented evidence that the handrails have been/were disinfected. During a concurrent observation and interview on [DATE], at 3:24 P.M., with CNA 2 was wearing a honey well N95 mask (Approved N95 respirator face masks provide protection against airborne particulates with a 95% filter efficiency against solid and liquid). CNA 2 stated she got the N95 mask from the front desk, however, she has not been fit tested for the N95 she was wearing. CNA 2 stated N95 mask have a tighter fit to prevent infection control. During a concurrent observation and interview on [DATE], at 3:31 P.M., LVN 1 was wearing a honey well N95 mask. LVN 1 stated she has not been fit for the N95 mask she was wearing. LVN 1 stated fit testing for N95 is done to determine the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055473 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 055473 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Vista Post-Acute Care Center 1516 Sawtelle Blvd. Los Angeles, CA 90025 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 - Few right N95 for the staff to wear to be protected from airborne infections and prevent getting contaminated. LVN 1 stated if the wrong N95 or one that was not approved based on the fit testing is worn, staff can get sick and could potentially get/pass covid. During a concurrent interview and record review, on [DATE], at 4:35 P.M., with the Director of Nursing (DON), Resident 5, Residents 6, Resident 7, and Resident 8 charts/immunization consents records and fit testing binders were reviewed. The DON stated that the facility process when going into a covid isolation room is that staff should wash hands with either soap and water or ABHR when entering and exiting a resident's room and should wear a face mask, gloves, and gown because the facility right was in a covid outbreak. The DON stated, this is done to protect each other from each other, to prevent and decrease infection. The DON stated not adhering to wearing the appropriate PPE is not adhered can lead to increased spread of the covid virus. The DON stated that the facility process for proper handling of laundry from a covid isolation room is that the covid isolation room should have its own hampers where the dirty linen can be stored and then properly transported to the laundry room where they are washed separately from the non-isolated linen. The DON stated staff should not be carrying the linen into the hallway because it can potentially spread the covid virus infection. The DON stated that high touch areas are hallway, residents' rooms, doorknobs, television (tv) remotes, any area that is frequently touched by residents is a high touch surfaces area. It is the responsibility of housekeeping to disinfect high touch surface areas. DON stated, I am not sure if high touch surface areas are disinfected every 2 hours, 6 hours or 8 hours. This is done to decrease the spread of infection and prevent possible infection. There should be a log that housekeeping should sign off once they have disinfected the high touch surface areas. The DON stated that if the resident or the residents RP consents to the vaccinations then the vaccines are given, documented in the point click care (PCC -a charting system used in nursing homes, assisted living and home care) under immunizations, an order is entered in the residents orders, then onto the electronic medication administration record (EMAR - a digital system that replaces paper-based charts for tracking how and when medications are given to patients) of the residents for the nurses to monitor the resident for adverse effects for 72 hours. The DON stated there is no documented evidence in the medical charts (electronic or physical) that Residents 5, 6, and 7 who had consented to receive influenza and covid 19 vaccinations received the vaccinations. The DON stated she is not sure why the residents did not receive their covid or influenza vaccinations even if they consented to them. The DON stated that Resident 5, 6, 7, and 8 did not have any consent or declination of the pneumonia vaccine and that there was no documented evidence that the pneumonia vaccine was given to the residents or that the residents had declined the vaccine, there is nothing under immunizations. The DON stated that covid 19 and influenza vaccines are recommended annually and if not given may lead to contracting the covid 19 or influenza virus which may lead to bad respiratory issues, possible hospitalization or death. The DON also stated that not having the pneumonia vaccine may also lead to respiratory issues such as shortness of breath, trouble breathing which may lead to hospitalization, and possibly death. The DON stated fit testing is done annually and upon staff hire to ensure that there are no changes such as weight gain or loss that could cause the mask to not fit properly so as to protect residents and staff, to ensure that nothing is coming in or going out of the respiratory system that could potentially affect the residents, preventing the spread of infection. The DON stated that if staff are not fit tested or are wearing the wrong N95 is, it may lead to infection and the spread of it. The DON stated that all facility staff fit testing are kept in the fit testing binder and there is no other place where they are kept. The DON stated after reviewing the fit testing binder that facility staff were last fit tested 11/2024 and should have been fit (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055473 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 055473 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/02/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE New Vista Post-Acute Care Center 1516 Sawtelle Blvd. Los Angeles, CA 90025 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete tested end of 11/2025. The DON stated that there is no documented evidence of N95 fit testing for CNA 2 and LVN. The DON stated that CNA 1 was last fit tested in 2023 and that there is no documented evidence of the current N95 fir testing. A review of the facility's Corona Virus Disease 2019 (COVID -19) Mitigation Plan, Reviewed [DATE], indicated, . Increase Frequency In Cleaning and Disinfecting High-Touch Surfaces at least every 4 hours using Bleach Wipes or EPA Approved Chemicals e.g. bed rails, call lights, handrails, doorknobs, nursing stations, medical chart cover, bedside tables Proper Laundering of LinensWhen caring for residents with respiratory infection and symptoms use Standard, Contact, and Droplet Precautions with eye protection.Required PPE: Fit-tested NIOSH N-95 Mask . Gown, Gloves and Eye Protection. A review of the facility's P&P titled, Infection Control Policy -Laundry Services Reviewed [DATE], indicated, Policy: It is the policy of the facility to assure a clean supply of linens and to protect employees who handle and process the laundry.Laundry includes resident's personal clothing, linens, (i.e., sheets, blankets, pillows), towels, washcloths, and items from departments such as nursing, dietary, rehab services, beauty shop, and environmental services. Regardless of where the laundry is processed, it is the facility's responsibility to ensure that all laundry is handled, stored, processed and transported in a safe and sanitary manner.All soiled linen should be bagged or put into carts at the location where they have been used. A review of the facility's P&P titled, Infection Control Program System Reviewed [DATE], indicated, Policy: The facility has an established infection prevention and control program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of communicable diseases and infections . Personnel must handle, store, process, and transport linens so as to prevent the spread of infection. A review of the facility's P&P titled, Fit Test and Respirator Seal Check Policy Reviewed [DATE], indicated, Policy: It is the facility's policy to adhered to OSHA guidelines. A ‘fit test' tests the seal between the N95 mask's, or respirator's, facepiece and your face. It typically takes 15-20 minutes to complete and should be performed when this type of mask is first used and then at least annually. Purpose: The purpose of the fit test is to assure that the mask fits and seals properly so potentially contaminated air cannot leak into the mask and so hazardous substances are kept out.Procedures: The fit test must be conducted using the same make, model, and size of mask that the worker will use on the job. Fit testing with a different type of mask than the one that will be used does not assure proper protection. 2. If the model of mask used for the fit test does not properly fit, another make, model, style, or size of mask must be tested until one that fits properly has been identified. 3. The Facility needs to provide staff with a reasonable selection of sizes and models to try. Once the fit test is completed and the wearer knows which mask fits best, he/she should always use the one shown to be the right ‘fit' or ‘size.' That way, it can be replaced with another mask with appropriate fit. Event ID: Facility ID: 055473 If continuation sheet Page 6 of 6