Health inspection·July 9, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 7/6/25 at 1640 hours, when RN 3 interviewed Resident 3, Resident 3 stated for the past one to two weeks, he had been feeling paranoid and increased the thought that people were trying to harm him and did not feel safe around the other residents. Resident 3 stated Resident 4 was outside with him earlier in the day and had touched him on his back. Resident 3 stated he felt threatened but did not share his feelings with the staff or other residents. Resident 3 stated when he saw Resident 4 sitting on the chair by the nurse's station, he decided to react and defend himself against Resident 4. Resident 3 stated he punched Resident 4 on the left side of his cheek and eye. Resident 3 was placed on the one-to-one care by the staff. - On 7/6/25 at 1730 hours, RN 3 observed Resident 3 running at a high rate of speed and jumping on Resident 4 who was still sitting in a chair by the nurses' station. Resident 3 began punching Resident 4 all over his body multiple times. The CNA who was providing the one-to-one care for Resident 3 in the dining room was running behind Resident 3 but could not catch up with Resident 3 before Resident 3 jumped on Resident 4.Review of Resident 3's plan of care dated 7/6/25, showed a care plan problem addressing Resident 3's two episodes of aggressive behaviors (punching Resident 4 multiple times on the face and body). The interventions included safeguarding the others by removing Resident 3 from the situation and/or providing the one-to-one supervision and for the staff to position themselves closely to supervise the resident and peers when in high traffic areas and allow space between peers. b. Medical record review for Resident 4 was initiated on 7/8/25. Resident 4 was admitted to the facility on [DATE].Review of Resident 4's H&P examination dated 4/3/25, showed Resident 4 could make needs known but could not make medical decisions. Review of Resident 4's eINTERACT Change of Condition dated 7/6/25 at 1640 hours, showed Resident 4 was punched with a closed fist on the face on the left eye and cheek by Resident 3. The documentation further showed Resident 4 complained of pain at the level of 5 (on the pain scale of 0 to 10 with 0 = no pain and 10 = most pain) to his left cheek and left eye, indicating moderate pain. Review of Resident 4's Hospital Transfer Form dated 7/6/25, showed Resident 4 was sent to the acute care hospital. The reason for the transfer showed another resident had punched him multiple times all over his body, including his head, which caused bleeding from the nose.Review of Resident 4's progress notes showed the following:- On 7/6/25 at 1640 hours, Resident 4 was observed sitting on a chair in the hallway near the medication cart next to the nurses' station. Resident 3 was observed pacing back and forth in the hallway near Resident 4 when suddenly Resident 3 punched Resident 4 with a closed fist on Resident 4's left eye and left cheek. The CNA and the staff were able to separate Residents 3 and 4, and Resident 3 was taken to the dining room. - On 7/6/25 at 1700 hours, Resident 4 complained of pain at the level of 5 to his left eye and left cheek. The PRN pain medication was administered to Resident 4.- On 7/6/25 at 1730 hours, RN 2 heard a loud sound and observed Resident 3 running towards Resident 4 who was sitting on a chair by the medication cart close to the nurse's station. Resident 3 then punched Resident 4 multiple times all over the body, including the resident's head. Resident 4 was observed with a bloody nose and increased redness and swelling to his face. Resident 4 complained of a headache and thought his nose might be broken. Resident 4's physician was notified, and Resident 4 was transferred to the acute care hospital for further evaluation. - On 7/6/25 at 2355 hours, showed Resident 4 returned from the acute care hospital at around 2300 hours. Resident 4 was observed with the redness above his right eyebrow and on the bridge of his nose, and a bluish/purplish discoloration below his left eye extending to his left cheekbone. The acute care hospital's diagnosis included facial contusion (injured tissue or skin) and right wrist pain. - On 7/7/25 at 1312 hours, Resident 4 emerged from his room and asked the staff if the resident (Resident 3) who attacked him was in the facility. Resident 4 was concerned about the resident who attacked him and wanted to stay away from (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055518 If continuation sheet Page 2 of 5 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 055518 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Newport Nursing and Rehabilitation Center 1555 Superior Avenue Newport Beach, CA 92663 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 him.On 7/9/25 at 1026 hours, an observation and concurrent interview was conducted with Resident 4. Resident 4 was observed with a reddish and bluish discoloration on the left eye. When asked if his left eye hurt, Resident 4 stated, it still burns. Resident 4 was asked how he sustained the discoloration on his left eye, Resident 4 stated someone punched him in the face but did not know why the other person punched him. Furthermore, Resident 4 stated the incident happened two times, one before dinner and the other was after dinner. On 7/9/25 at 1328, a telephone interview was conducted with CNA 2. CNA 2 stated Resident 3 punched Resident 4's left side of the face. CNA 2 stated the first incident happened before the dinner in front of the nurses' station. The second incident happened after the dinner when Resident 3 ran from the TV room and hit Resident 4 multiple times in the body and face. CNA 2 stated he did not know which staff was supervising Resident 3 in the TV room. On 7/9/25 at 1502 hours, an interview was conducted with CNA 5. CNA 5 stated he did not observe the first incident when Resident 3 punched Resident 4. However, CNA 5 stayed with Resident 3 while the resident was in the dining area after the first incident. CNA 5 stated he sat behind Resident 3 in the dining room with a round dining table in between them. Resident 3 stood up and started pacing. When Resident 3 was closed to the door, CNA 5 asked the resident what he was doing and where he was going. Resident 3 then sprinted out of the dining room door and CNA 5 ran after the resident. Resident 3 then started punching Resident 4 close to the nurse's station.On 7/9/25 at 1456, an interview was conducted with the DON. The DON was informed and acknowledged the above findings. Event ID: Facility ID: 055518 If continuation sheet Page 3 of 5 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 055518 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Newport Nursing and Rehabilitation Center 1555 Superior Avenue Newport Beach, CA 92663 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **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 maintain a safe and secured environment for two of five sampled residents (Residents 1 and 2).* The facility failed to ensure there were systems in place to prevent Residents 1 and 2 from eloping. This failure placed the residents at risk for harm or injury. Findings:Review of the facility's P&P titled Behavioral Health Elopement revised on 5/1/24, showed the definition of elopement as a situation in which a resident leaves the premises or a safe area without the facility's knowledge and supervision. This situation represents a risk to the resident's health and safety and places the resident at risk of heat or cold exposure, dehydration and/or other medical complications, drowning or being struck by a motor vehicle.Review of the incident report of the DON dated 6/23/25, showed at approximately 1950 hours on 6/20/25, Residents 1 and 2 had left the premises through the west exit door.1. Closed medical record review for Resident 1 was initiated on 7/8/25. Resident 1 was admitted to the facility on [DATE], and discharged on 6/20/25. Review of Resident 1's Elopement Risk dated 3/26/25, showed Resident 1 was placed in a locked/secured (egress) facility. Review of the Resident 1's Care Plan Report initiated on 4/21/25, showed a care plan problem addressing the resident's risk for elopement related to involuntary placement and history of elopement.Review of Resident 1's MDS assessment dated [DATE], showed the resident was independent in making decisions regarding tasks of daily life. Review of Resident 1's eINTERACT Change of Condition Evaluation dated 6/20/25, showed Resident 1 was observed leaving AMA through the back door during the smoke break. The resident left the facility by kicking the exit door. 2. Closed medical record review for Resident 2 was initiated on 7/8/25. Resident 2 was admitted to the facility on [DATE], and discharged on 6/20/25.Review of Resident 2's H&P examination dated 6/19/25, showed Resident 2 could make needs known but could not make medical decisions.Review of Resident 2's eINTERACT Change of Condition Evaluation dated 6/20/25, showed Resident 2 was observed leaving through the alarmed back door during the smoke break. Resident 2 had a history of leaving the previous facility with her partner.Review of Resident 2's Care Plan Report initiated on 6/19/25, showed a care plan problem addressing the resident's risk for elopement related to involuntary placement.On 7/8/25 at 0925 hours, a video of the elopement incident on 6/20/25 was shown by the Administrator. Resident 2 was seen trying to climb over the white fence and Resident 1 was kicking the exit door. Both Residents 1 and 2 were able to get out of the facility through the exit door. After a minute or two, two facility staff were observed running after the residents.On 7/8/25 at 1016 hours, an observation and concurrent interview was conducted with the Maintenance Director. The Maintenance Director showed the two exit doors in the smoking area. The Maintenance Director stated an alarm could be heard if the door was forcefully opened and without a key. On 7/9/25 at 0924 hours, an interview was conducted with Resident 5. Resident 5 stated he saw Resident 1 kick the exit door and left the facility with Resident 2. Resident 5 stated there was no licensed nurse or facility staff by the exit door. Resident 5 stated the facility staff then ran after Residents 1 and 2 when they heard the banging of the exit door.On 7/9/25 at 1034 hours, a telephone interview was conducted with CNA 1. CNA 1 stated Residents 1 and 2 were observed walking around the courtyard until the facility staff heard a big bang towards the back gate/exit door. CNA 1 then observed Residents 1 and 2 running through the exit door. CNA 1 stated the exit door would make an alarm sound when someone tried to open, push, or touch it. However, at the time when Residents 1 and 2 left through the exit door, the facility staff just heard the banging of the exit door, but no alarm sound was heard.On 7/9/25 at 1136 hours, an interview was conducted with MHW 2. MHW 2 stated the elopement incident happened around (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055518 If continuation sheet Page 4 of 5 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 055518 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Newport Nursing and Rehabilitation Center 1555 Superior Avenue Newport Beach, CA 92663 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 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 1950 hours on 6/20/25. MHW 2 stated he heard a door banging. MHW 2 then ran towards the exit door and saw Residents 1 and 2 running towards the street. MHW 2 stated if the exit door was pushed open, an alarm would sound. However, at the time of the incident, MHW 2 stated he just heard the banging of the door, and no alarm sound was heard.On 7/9/25 at 1627 hours, a telephone interview was conducted with the Maintenance Director. The Maintenance Director stated he checked all the doors everyday, especially the exit doors. When asked if there was a maintenance log to show when the exit doors were checked for proper function, the Maintenance Director stated no. On 7/9/25 at 1640 hours, an interview was conducted with the Administrator and DON. The Administer and DON was informed and acknowledged the above findings. Event ID: Facility ID: 055518 If continuation sheet Page 5 of 5