Health inspection·January 27, 2022

F 0689 Level of Harm - Minimal harm or potential for actual harm fall, but not after the 9/1/21 fall. There was also no IDT note after the 9/1/21 fall. She confirmed the post fall evaluation, dated 9/1/21, indicated to see progress note under the summary section of the incident, with no other details about the fall. DON said the IDT note was the documentation that included the discussion about the cause of the fall and new interventions, if possible, to prevent future falls, as per their facility protocol, but this was not done after Resident 4 fell on 9/1/21. Residents Affected - Few The facility Falls - Clinical Protocol, revised 9/2012, was reviewed. It indicated, based on the preceding assessment, the staff and physician will identify pertinent interventions to try to prevent subsequent falls and to address risks of serious consequences of falling. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055510 If continuation sheet Page 2 of 12 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 055510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redding Post Acute 1836 Gold Street Redding, CA 96001 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 0711 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure the resident's doctor reviews the resident's care, writes, signs and dates progress notes and orders, at each required visit. Based on interview, and record review the facility failed to ensure resident's symptoms and distress were addressed on timely manner when existing nursing treatment and or medication did not improve the symptoms in one out of 17 sampled residents (Resident 52). This failure could contribute to unsafe care and/or resident's comfort level. Findings: During Resident 52's medical record review titled Medication Administration Record (or MAR, a legal drug chart where nurse documented medications administration and monitoring), with date range of 1/1/22 to 1/31/22, the MAR indicated a medication order for Benadryl (or diphenhydramine, a medication used to treat allergy symptoms such as itching) as follow: Benadryl Allergy Tablet 25 mg (mg is a measure of unit), [diphenhydramine HCL]: Give 25 mg by mouth every 6 hours as needed for itching- Order Date- 6/25/21. Further review of the MAR indicated Benadryl medication was administered up to 3 times per day for itching. During review of Resident 52's nursing Care Plan (Care Plan was a nursing record of how to identify and address resident's needs and potential risks related to medication and other health issues), initiated on 1/3/22, the Care Plan indicated The resident has potential/actual impairment to skin integrity . shearing, bruising and scratches. The Care Plan on the Intervention section, indicated identify/document potential causative factors and eliminate/resolve where possible; Date initiated: 1/3/22. Review of a nursing communication document with Medical Doctor 1 (MD 1), dated 1/24/22, regarding Resident 52, the note indicated Resident is picking on RUA (Right Upper Arm); Now has open areas, start to weep clear secretions. Review of the Resident 52's medical record under Nursing Note, written by Registered Nurse 1 (RN 1) on 1/26/22 at 09:07 AM, the note indicated It was noticed to have sleeves on both shoulders having spots of wetness, looking at BUE ( means both sides of the upper body extremities), arms were seen with self-inflicted scratch/picking areas that were leaking copious amounts of clear, yellow serous fluids (serous a type of body fluid). The RN 1 note under assessment indicated . Benadryl ineffective. RN 1 note under recommendation indicated request for hydroxyzine (a medication for itching) scheduled med ( means medication) and wound referral .PRN creams also advised. In an interview with RN 1 on 1/26/22 at 1:20 PM, RN 1 stated Resident 52 has had an ongoing issue with scratching the skin with subsequent shearing and leaking yellow fluid from the scratch spots. RN 1 stated the current treatment plan had not helped alleviate the uncomfortable itching. RN 1 stated the medication prescribed was not helping as the resident's skin swelling (or edema) had worsen due to kidney not working very well. RN 1 acknowledged that the root cause of itching should be first addressed in addition to topical treatment by medical provider that so far had been ineffective. Review of the Resident 52's medical record in the paper chart under Physician Progress Notes (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055510 If continuation sheet Page 3 of 12 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 055510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redding Post Acute 1836 Gold Street Redding, CA 96001 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 0711 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few section, indicated the MD-1's most recent progress notes were documented on 12/31/21 and 11/19/21. Further review of these two progress notes indicated, MD-1 had signed and dated the exact same progress note with no new information from one visit to another on 11/19/21 and 12/31/21. In a telephone interview with MD-1 on 12/27/22 at 9 AM, MD-1 stated that he did not remember Resident 52's medical condition as he did not have access to electronic medical chart. MD-1, however, could recall that he signed an informed consent for Resident 52 on 12/31/21. MD-1 stated that Resident 52's skin condition should be referred to a skin specialist. MD-1 was not aware of nursing communication regarding Resident 52's itching, scratching and severe edema with leaking yellow serous fluid on the skin. In an interview with Director of Nursing (DON) on 1/27/22 at 9:45 AM, in her office, the DON stated that she expected the medical doctors or providers provide timely guidance to the nursing staff on how to deliver the best care. DON stated, it was expected that the medical providers address the resident's suffering or change of condition by providing guidance such as nursing care, lab work or medications when needed. DON stated, she was not aware of nursing staff needed to get a hold of MD 1 to address wounds, itching and skin issue when Benadryl was not helping to alleviate the symptoms. Review of facility's policy titled Medication Therapy, last revised on 4/2007, the policy indicated 4. Periodically, and when circumstances are present ., the staff and practitioner will review the medication regimen for continued indication, proper dosage and duration, and possible adverse consequences; 5. The Physician will identify situations where medications should be tapered, discontinued, or changed . Review of facility's policy titled Medical Director, last revised 7/2016, the policy indicated 3 b. Acting as a consultant to the director of nursing services in matters relating to resident care services; 3 c. Helping assure that the resident receive adequate services appropriate to meet their needs; 3rd. Helping assure that the resident care plan accurately reflects the medical regimen. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055510 If continuation sheet Page 4 of 12 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 055510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redding Post Acute 1836 Gold Street Redding, CA 96001 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 0757 Ensure each resident’s drug regimen must be free from unnecessary drugs. Level of Harm - Minimal harm or potential for actual harm Based on interview, and record review the facility failed to ensure high risk anticoagulant medication (or blood thinner medication that may cause bleeding) was monitored on daily basis by nursing staff for possible adverse effects of the medication in one out of 17 sampled residents (Resident 28). Residents Affected - Few This failure could result in unsafe medication use in the facility. Findings: During a review of Resident 28's medical record titled Medication Administration Record (or MAR, a legal drug chart where nurse documented medications administration and monitoring), the MAR indicated a doctor's medication order for rivaroxaban (or Xarelto, a blood thinner or anticoagulant medication) as follow: Rivaroxaban Tablet 20 mg (mg is a measure of unit); Give 20 mg by mouth in the evening for prevention of DVT/PE (DVT stands for Deep Vein Thrombosis which was blood clot in the leg's arteries and PE stands for Pulmonary Embolism which was blood clot in the lung; both conditions could cause resident harm); order date: 8/14/2021 Review of the Resident 28's nursing Care Plan (Care Plan correctly identified resident's needs and potential risks related to medication and other health issues) with initiation date of 5/18/2019, the Care Plan document for anticoagulant (blood thinner) medication called Xarelto, indicated a goal of Resident will be free from discomfort or adverse reactions related to anticoagulant use though the review date . Target date: 03/01/2022. Further review of the Care Plan document under Interventions indicated, Administer ANTICOAGULANT medication as ordered by physician. Monitor for side effects and effectiveness Q-SHIFT (means every work shift) . The Care Plan document further indicated BBW (or Black Box Warning- the highest level of warning issued by drug manufacturer and/or United States Food and Drug Administration on use of high-risk medications) Monitor for side effects of anticoagulants: S/S (means Signs and Symptoms) of abnormal bleeding, black stools, red or dark urine, coffee ground emesis, red spots on skin, unusual bruising, bleeding from eye, gums, nose . Review of the Resident 28's MAR, where the nursing staff were guided to monitors resident's response to medication or adverse effects, the MAR did not show daily nursing monitoring for side effects such as bleeding or bruising from use of a high-risk blood thinner based on the plan of care. In an interview with the Director of Nursing (DON) in her office, on 1/27/22 at 9:45 AM, the DON stated for anticoagulation safety, the facility did lab monitoring and monitored for side effects such as bleeding, like gum bleed, or bruises on the MAR for nurse documentation. The DON acknowledged there was no specific monitoring line in the MAR to document the serious side effects of Xarelto, although the plan of care indicated the need for every shift monitoring. Review of the facility's policy titled Anticoagulation- Clinical Protocol, last revised on 09/2012, the policy under Assessment and Recognition, indicated Assess for any sign or symptoms related to adverse drug reactions due to the medication alone or in combination with other medications. The policy under the Treatment/Management, indicated The staff and physician will identify and address potential complications in individuals receiving anticoagulation. Review of the facility's policy titled Medication Regimen Reviews, last revised on 5/2019, the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055510 If continuation sheet Page 5 of 12 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 055510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redding Post Acute 1836 Gold Street Redding, CA 96001 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 0757 policy indicated the MRR involves a thorough review of the residents' medical record to prevent, identify . medication . and other irregularities, for example: . inadequate monitoring for adverse consequences. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055510 If continuation sheet Page 6 of 12 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 055510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redding Post Acute 1836 Gold Street Redding, CA 96001 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 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. Based on observation, interview, and record review, the facility failed to ensure house supply medications in the Central Supply Storage room (a storage room in the facility for non-prescription medications) were stored at a safe controlled room temperature in one out of three medication storage areas and a census of 54 residents. This failure could potentially cause medication to become ineffective if stored outside the manufacturer's recommended temperature guidelines. Findings: During an observation and tour of the facility's Central Supply Storage (a room that stored medical supplies and non-prescription or Over the Counter [OTC] medications) on 1/24/22 at 9:05 AM accompanied by LVN 1, the small storage room stored shelves of OTC medications, medical supplies, and multiple computer wiring's that served the facility's computer needs. The small storage room's temperature was warm upon entrance to the room. LVN 1 confirmed the warm temperature while standing in the unvented storage room. Further observation with LVN 1, it was confirmed the facility did not monitor room temperature for the Central Supply Storage room and there was no temperature monitoring device was installed in the room. During the tour of the Central Supply Storage room on 1/24/22 at 9:05 AM, the following medications were a random example of medication or supplies where the labeling indicated the need for controlled room temperature for storage: *Assure Platinum Blood Glucose Test Strips (a test strip used to measure accurate blood sugar): The label on the box indicated store between 39-86-degree Fahrenheit (Fahrenheit was a scale of temperature) *Omeprazole Delayed Release Tablet: Acid Reducer (med used for heartburn); The label on the box indicated Store at 20-25 degree Celsius (66-77-degree Fahrenheit) and protect from moisture. Celsius was another scale of temperature) *Probiotic (Saccharomyces boulardii), Dietary supplement: The label on the bottle stated, store at controlled room temperature. During an interview with the Director of Nursing (DON) on 1/25/22 at 3:11 PM, the DON was not aware of temperature issues in the Central Supply Storage room. DON stated she never thought that was an issue and appreciated a different eye to see the problem. The DON stated that the facility had enough storage areas to correct the storage environment by moving the medications to a well vented area with room temperature monitoring. Review of the facility's policy titled Storage of Medications, last revised in April 2019, the policy indicated Drugs and biologicals used in the facility are stored in locked compartments under proper temperature, light and humidity controls. . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055510 If continuation sheet Page 7 of 12 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 055510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redding Post Acute 1836 Gold Street Redding, CA 96001 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 0812 Level of Harm - Minimal harm or potential for actual harm Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observation and interview, the facility failed to ensure food was prepared in a clean sanitary manner. This had the potential to cause food borne illnesses to the residents. Residents Affected - Many Findings: During an observation on 1/25/22 at 10:15 am, the trash can in the food prep area had a lid, without foot controls, so staff had to use their hands to open and close the lid. The facility cook (FC) opened the trash can lid with her hand, threw away trash, closed the trash can lid with her hand, then picked up spices and continued in her meal prep, without hand hygiene. During an interview on 1/25/22 at 10:20 am, this was discussed with the Dietary Services Manager (DSM)who agreed they needed a trash can with a lid that could be opened with foot controls. He said he would talk to the Administrator about getting a new one. During an observation on 1/25/22 at 2:40 pm, the gas line-valve next to the stove/oven was covered with dust and what appeared to be spider webs (see pictures). This was immediately showed to the DSM who confirmed the observation and said he would make sure it was cleaned right away. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055510 If continuation sheet Page 8 of 12 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 055510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redding Post Acute 1836 Gold Street Redding, CA 96001 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** 5. During observations on 1/24/22 at 9:35 am, there were no gloves in the isolation carts in front of rooms [ROOM NUMBERS], and only one gown left in the isolation cart for room [ROOM NUMBER]. During an interview on 1/24/22 at 10 am, the Director of Nurses (DON) confirmed the above and said they had personal protective equipment (PPE) in the carts earlier but staff have been going through them a lot, to go into the rooms and answer call lights. Residents Affected - Many During observations on 1/24/22 at 9:35 am, there was no hand sanitizer in the hallway outside rooms [ROOM NUMBER] and none on the isolation carts in front of these rooms. The hand sanitizer for these three rooms was located inside the room on the wall for the bed closest to the hall. However, it was so far inside the room, that one had to enter the room a few feet, and push the resident privacy curtain aside, before having access to the hand sanitizer. During an interview on 1/24/22 at 10 am, the lack of access to hand sanitizer was discussed with DON who confirmed the above observations and said she thought there was some in the hallway outside the rooms at one time. During an observation on 1/25/22 at 8 am, there was no hand sanitizer seen on isolation carts in front of rooms 30, 31 and 32. This was immediately discussed with the Infection Preventionist (IP) Nurse. In room [ROOM NUMBER], the resident's bed prevented access to the hand sanitizer on the wall, in room [ROOM NUMBER] a decoration on the wall prevented access to hand sanitizer, and in room [ROOM NUMBER], the privacy curtain would have to be opened, to have access to the hand sanitizer. The IP confirmed these observations and said the Administrator was bringing sanitizer containers to place on the walls in the hallway outside the room. 4. On 1/24/22 12:56 PM During rounding on the above residents observed isolation carts for rooms 1-7, 33 & 34. Closest hand sanitizer is inside the resident rooms behind privacy curtains making it impossible to sanitize appropriately before and after donning/doffing. 01/24/22 04:40 PM Interview with the Assistant Facility Administrator (AFA) regarding availability of hand sanitizer on isolation carts. There is sanitizer in each room and also along the hallways near the nurses station. When asked about the process of donning and doffing PPE the AFA did not know sanitizing was part of the process. The AFA stated he would get sanitizer placed on the isolation carts and install more dispensers on the hallway walls. Based on observation, interview, and record review the facility failed to establish and maintain an infection prevention and control program to provide a safe, and sanitary environment and to help prevent the transmission of infections with the census of 54 when: 1. Two out of two medication carts (a mobile cart used to store the medication and supplies for quick access for administration to residents) had unclean pill cutter (a small device that splits individual pills) shared among residents. 2. Licensed Nurse 4 (LVN 4) did not follow infection control practices when entered resident's rooms without following facility's policy on Transmission Based Disease (or same as TBP or Transmission Based Precaution used to help stop the spread of germs from one person to another by using protective measures such as putting gloves, sanitizing hand and putting on the gown and mask) before entering (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055510 If continuation sheet Page 9 of 12 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 055510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redding Post Acute 1836 Gold Street Redding, CA 96001 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 the rooms on three resident's rooms (Resident 41, Resident 23, Resident 36) with census of 54. Level of Harm - Minimal harm or potential for actual harm 3. The shared glucometer (a device that measured blood sugar by using resident's blood droplet) was not sanitized based on standards of care and the manufacturer recommendations in one of 54 residents (Resident 23). Residents Affected - Many 4. Hand sanitizers were not located in a convenient location for quick and safe access by staff caring for residents. 5. Personal Protective Equipment (PPE)d, used to protect transmission of infection was not fully available and accessible in the facility's hallway prior to entrance to resident rooms. These failures had the potential for all residents in the facility to contract infectious diseases. Findings: 1. During an observation on 1/14/22 at 10:15 AM with Licensed Vocational Nurse (LVN) 3, in facility's Zone 3 hallway, the pill cutting device inside the medication cart was noted to have white color powder debris inside from prior use. LVN 3 confirmed that it was dirty and needs to be cleaned. During an observation on 1/24/22 at 2:15 PM with Licensed Vocational Nurse (LVN) 2, in facility's Zone 2 hallway, the pill cutting device inside the medication cart was noted to have white color powder debris inside from prior use. LVN 2 confirmed that it looks like it needed to be cleaned. During an interview with the Director of Nursing, (DON), on 1/27/22 at 9:30 AM, the DON stated the pill cutters should be cleaned after each use to prevent cross contamination. Review of the facility's policy titled General Infection Control Practices, last revised on 1/2012, the policy on page 29 under 7 b, indicated If use of common items is unavoidable, then adequately clean and disinfect them before use for another resident. 2 a. During a medication pass observation with LVN 4, on 1/26/22 at 6:45 AM, LVN 4 entered Resident 41's room without putting on gloves before entering the room. LVN 4 was observed touching surfaces, curtains, and Resident 41 with bare hands. Resident 41 was in a room that required Transmission Based Precautions (TBP) which included to use of gown, gloves, and eye protection in addition to hand sanitizing when entering and exiting the room. 2 b. During a medication administration observation with LVN 4, on 1/26/22 at 6:51 AM, LVN 4 did not put on gloves before entering Resident 23's room. LVN 4 touched curtains, bedrails surfaces and the resident with bare hands. 2 c. During a medication administration observation with LVN 4, on 1/26/22 at 7:00 AM, LVN 4 did not put on gloves before entering Resident 36's room. LVN 4 put on gloves prior to insulin shot (a medication used to treat diabetes or blood sugar disease) administration without hand sanitization while inside resident's room and after touching surfaces and bedrails. During an interview with LVN 4, on 1/26/22 at 3:30 PM, LVN 4 acknowledged that she should have been putting gloves on and using hand sanitizer before and after entering the residents' rooms. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055510 If continuation sheet Page 10 of 12 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 055510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redding Post Acute 1836 Gold Street Redding, CA 96001 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 - Many During an interview with the Director of Nursing (DON), on 1/27/22 at 9:30 AM, the DON stated that the nursing staff should have followed the facility's policy on hand hygiene and glove use prior to entering TBP rooms. During an interview with Infection Control Nurse (IP), on 1/26/22 at 2:10 PM, IP stated that the residents in Zone 1, 2 and 3 were in Transmission-Based Precautions (a form of isolation), and that signs were posted outside all the rooms to remind staff and visitors of the requirements. IP confirmed that TBP would include hand sanitizing, putting on gown, gloves, and eye protection in addition to mask before entering residents' rooms. IP stated that spot audits (random checks on following the procedure) were performed regularly, however, there was no formal process to document the audits. 3. During a medication pass observation with LVN 2 on 1/25/22 at 11:09 AM, LVN 2 used a shared device called glucometer (device used to measure blood sugar) to measure Resident 15's blood sugar. LVN 2 entered the Resident 15's room and measured the blood sugar by poking the fingertip with a needle and then administered the insulin (a medication to help lower blood sugar) as ordered by the doctor. LVN 2, after exiting the resident's room, wiped the glucometer surface with sanitizing wipe labeled Bleach Germicidal Wipes for less than 30 seconds. LVN 2 subsequently placed the glucometer in the drawer on top of a clean tissue. In an interview with the LVN 2 on 1/25/22 at 11:13 AM, LVN 2 stated that she was instructed to leave the glucometer on a surface to dry out after wiping. During an interview with the Director of Nursing (DON), on 1/27/22 at 9:30 AM, the DON stated the policy on shared devises was to sanitize the device appropriately in-between residents' use. The DON stated the nursing staff should have followed the facility's policy on glucometer cleaning and sanitization in-between resident use. The DON stated facility's IP nurse should have given feedback and monitored the compliance. Review of the facility's policy titled Blood Sampling, Capillary (Finger Sticks), last revised on 9/14, the policy indicated 8. Following the manufacturer's instructions, clean and disinfect reusable equipment, parts, and/or devices after each use. Review of the glucometer manufacturer information sheet for ASSURE PLATINUM BLOOD GLUCOSE MONITORING SYSTEM( the name of glucometer brand), last accessed on 2/1/22, the information sheet indicated The meter should be cleaned and disinfected after use on each patient. The cleaning procedure is needed to clean dirt, blood, and other bodily fluids off the exterior of the meter before performing the disinfecting procedure. The disinfecting procedure is needed to prevent the transmission of blood-borne pathogens. Review of the facility's sanitization wipe instructions for this product Clorox, Healthcare Bleach Germicidal Wipes, last accessed on 2/1/22, the manufacturer's product instruction indicated the following steps for effective sanitization: *Remove gross soil if present . *Wipe the surface until completely wet. *Wait for the contact time (3 minutes for all pathogens listed on the product label). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055510 If continuation sheet Page 11 of 12 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 055510 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/27/2022 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Redding Post Acute 1836 Gold Street Redding, CA 96001 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 *Discard the wipe. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Many FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055510 If continuation sheet Page 12 of 12