Inspection·August 12, 2023

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 2 stated, on July 11, 2023, during the Resident Council Meeting, Resident 2 reported [NAME] 1 ' s behavior. Resident 2 stated, on several occasions that she had requested for other meal alternatives in the kitchen, [NAME] 1 was rude and responded, I can ' t be bothered, I don ' t have time for this. Resident 2 further stated, on multiple occasions she (Resident 2) went to the kitchen and found the kitchen ' s door closed, and after repeatedly knocking, [NAME] 1 would finally open the door and responded, No, you need to ask someone else, in a very rude tone. Resident 2 stated [NAME] 1 ' s tone made her feel sad, like I don ' t belong here [facility]. During an interview with the Dietary Supervisor (DS), on August 8, 2023, at 9:38 AM, the DS stated, the expectation for the staff in the kitchen was to offer meal alternatives when residents requested, treat all residents with respect, and not to yell at them. During an interview with a Dietary Aide (DA 1), on August 8, 2023, at 9:45 AM, DA 1 stated, [NAME] 1 was very rude to residents, especially with Resident 1. DA 1 stated, when Resident 1 approached [NAME] 1 to request a meal alternative, [NAME] 1 responded, I don ' t have time to make you another alternative, in a very mean tone. DA 1 further stated, [NAME] 1 would lock the kitchen door on several times because she (Cook 1) did not wanted to be bothered by the residents. DA 1 further stated she could hear the residents knocking at the door, and when DA 1 asked [NAME] 1 about locking the door, [NAME] 1 responded, I am tired of [name of Resident 1] coming to the door and ask for stuff. During an interview with a [NAME] (Cook 2), on August 8, 2023, at 9:51 AM, [NAME] 2 stated, when residents go to the kitchen and asked questions to [NAME] 1 regarding food, [NAME] 1 was always irritated and answered in a bad mood. [NAME] 2 stated, on several occasions she heard [NAME] 1 responding to residents, I already told you it ' s too late, you are not going to get it, when residents requested for other meal alternatives. [NAME] 2 further stated, [NAME] 1 ' s tone appeared like she was being annoyed, was not happy, looked upset. [NAME] 2 stated, on many occasions, when Resident 1 went to the kitchen, [NAME] 1 locked both doors and stated, I am not going to answer the door to her [Resident 1], while Resident 1 keep knocking on the door. During an interview with the Administrator (Admin), on August 8, 2023, at 10:58 AM, the Admin stated, [NAME] 1 was terminated on July 21, 2023, because after facility investigation, it was concluded the allegation of verbal abuse (act of harassing, labeling, insulting, scolding, rebuking or excessive yelling towards an individual) was substantiated. During a concurrent interview and record review, with the Admin, on August 8, 2023, at 11:28 AM, the Admin reviewed a facility document titled, Abuse Prevention Program, revised August 2021, which indicated, . As part of the resident abuse prevention, the administration will: . 1. Protect our residents from abuse by anyone, including but not necessarily limited to facility staff, other residents, consultants, volunteers, staff from other agencies, family members, legal representatives, friends, visitors or any other individual. The Admin stated employed did not follow the policy for Abuse Prevention. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055650 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 055650 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Care Center of Redlands 700 E Highland Ave Redlands, CA 92374 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 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on observation, interview, and record review, the facility failed to ensure their abuse investigation and reporting policy and procedure was being implemented for two of three residents (Residents 1 and 2), when Residents 1 and 2 reported an allegation of verbal abuse (act of harassing, labeling, insulting, scolding, rebuking or excessive yelling towards an individual) from [NAME] 1, on July 11, 2023, and facility reported incident on July 14, 2023 (3 days after the allegation was made). Residents Affected - Few This failure had the potential for Residents 1 and 2 not be protected from further potential abuse and experience psychosocial harm. Findings: During a concurrent observation and interview, on July 18, 2023, at 12:00 PM, inside of Resident 1 ' s room, Resident 1 was sitting on her wheelchair, in front of the nurses ' station. Resident 1 stated, on July 11, 2023, during the Resident Council Meeting, Resident 1 reported [NAME] 1 was rough when talked to. Resident 1 further stated she was afraid of her, when she needs to go to the kitchen for any request. Resident 1 stated it was an ongoing situation, and [NAME] 1 always raised her voice when Resident 1 asked for something. During a concurrent observation and interview, on August 8, 2023, at 9:15 AM, inside of Resident 2 ' s room, Resident 2 was lying on her bed, with the head of the bed elevated, eating breakfast. Resident 2 stated, on July 11, 2023, during the Resident Council Meeting, Resident 2 reported [NAME] 1 ' s behavior. Resident 2 stated, on several occasions that she had requested for other meal alternatives in the kitchen, [NAME] 1 was rude and responded, I can ' t be bothered, I don ' t have time for this. Resident 2 further stated, on multiple occasions she (Resident 2) went to the kitchen and found the kitchen ' s door closed, and after repeatedly knocking, [NAME] 1 would finally open the door and responded, No, you need to ask someone else, in a very rude tone. Resident 2 stated [NAME] 1 ' s tone made her feel sad, like I don ' t belong here [facility]. During a review of the Resident Council Minutes (record of what decisions were made, who was in attendance and what events occurred during residents ' meeting to discuss and address concerns about their rights and quality of care received from staff), dated July 11, 2023, it indicated, . Dietary: . Dietary Supervisor Came into resident council and met with all residents to discuss likes and dislikes and made notes of it . 124 A [name of Resident 1] - 128A [name of Resident 2] - Residents state that the girl in the kitchen with tattoos [name of [NAME] 1] has poor customer service and is not welcoming and speaks in a stern tone. During an interview with the Activities Director (AD), on August 8, 2023, at 9:28 AM, the DA stated, Residents 1 and 2 reported the girl in the kitchen with the tattoos, have poor customer service and talk in stern tone (inflexible, firm, strict or authoritarian tone of voice), referring to [NAME] 1, on July 11, 2023, during the Resident Council Meeting. The AD stated she reported the incident to the Administrator (Admin), immediately after the meeting. During an interview with the Dietary Supervisor (DS), on August 8, 2023, at 9:48 AM, the DS stated, she was present during the Resident Council Meeting conducted on July 11, 2023, and received the allegation of verbal abuse from Residents 1 and 2 against [NAME] 1. The DS stated she immediately reported it to the Admin. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055650 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 055650 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/12/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Highland Care Center of Redlands 700 E Highland Ave Redlands, CA 92374 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 0607 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few During a review of document title Report of suspected Dependent Adult/Elder Abuse, dated July 14, 2023 (three days after the Resident Council), sent by the Administrator (Admin) to the State Survey Agency, it indicated On 7/14/23 [July 14, 2023], [name of Resident 1] reported to Activities Director that the morning cook with the tattoo ' s screams at to her residents and raises her voice at her. It ' s her attitude towards us when we ask her for stuff and she makes me feels I ' m a bother to her. I don ' t think she fits the team. When she is on shift, I try my best to stay away and not to ask for anything because I don ' t want to stress myself out. During a review of document title Report of suspected Dependent Adult/Elder Abuse, dated July 14, 2023 (three days after the Resident Council), sent by the Admin to the State Survey Agency, it indicated On 7/14/23 [July 14, 2023], [name of Resident 2] reported to Activities Director that the morning cook with the tattoo ' s screams at to her residents and raises her voice at her. It ' s her attitude towards us when we ask her for stuff and she makes me feels I ' m a bother to her. I don ' t think she fits the team. When she is on shift, I try my best to stay away and not to ask for anything because I don ' t want to stress myself out. During an interview with the Admin, on August 8, 2023, at 10:58 AM, the Admin stated, [NAME] 1 was terminated on July 21, 2023, because after facility investigation, it was concluded the allegation of verbal abuse was substantiated. During a concurrent interview and record review, with the Admin, on August 8, 2023, at 11:20 AM, the Admin reviewed a facility provided document titled, Current Pay Period, for [NAME] 1, from July 9, 2023 to July 22, 2023, the Admin acknowledged [NAME] 1 last day of work was on July 12, 2023, from 5:18 AM to 1:46 PM. (The allegation of verbal abuse by [NAME] 1 were made by Residents 1 and 2 on July 11, 2023). During a concurrent interview and record review, with the Admin, on August 8, 2023, at 11:23 AM, the Admin reviewed the facility ' s policy and procedure titled, Abuse Investigation and Reporting, revised July 2017, and stated the policy was not followed. The Admin further stated the allegation was reported to the State Agency on July 14,2023, instead of July 11, 2023, because she did not think it was an allegation of verbal abuse. During a review of the facility ' s policy and procedure titled, Abuse Investigation and Reporting, revised July 2017, it indicated, All reports of resident abuse, neglect, exploitation, misappropriation of property, mistreatment and/or injuries of unknown source (abuse) shall promptly reported to local, state, and federal agencies (as defined by current regulations) . 4. The Administrator will suspend immediately any employee who has been accused of resident abuse, pending the outcome of the investigation . Reporting . 2. Any alleged violation of abuse, neglect exploitation or mistreatment (including injuries of unknown source and misappropriation of resident property) will be reported immediately, but not later than . a. Two (2) hours if the alleged violation involves abuse . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055650 If continuation sheet Page 4 of 4