Inspection visit

Health inspectionFebruary 24, 2023

PARKVIEW HEALTHCARE CENTERCMS #05567113 citations on this visit

13 citations recorded

Inspector’s narrative

What the inspector wrote

This survey cited 13 deficiencies. The full statement and the facility’s plan of correction follow, verbatim from the federal record.

F 0554 Allow residents to self-administer drugs if determined clinically appropriate. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, facility document review, and facility P&P review, the facility failed to ensure one of 13 final sampled resident (Resident 8) did not have access to administer the medications when the resident was assessed to be unable to self-administer the medications safely, and the medications were not ordered by the physician. This had the potential for Resident 8 to be harmed by unsafe practices. Residents Affected - Few Findings: Review of the facility's P&P titled Self-Administration of Medications revised February 2021 showed the interdisciplinary team will assess each resident's cognitive and physical abilities to determine if self-administration is safe and appropriate for the resident and nursing staff will document self-administration of medications in the MAR. The P&P also showed medications found at the bedside that are not authorized for self-administration will be returned to the charge nurse to be returned to the family. Review of the facility's P&P titled Administering Medications revised April 2019 showed medication are administered in accordance with the physician's orders. Medical record review for Resident 8 was initiated on 2/21/23. Resident 8 was admitted to the facility on [DATE]. Review of Resident 8's History and Physical Examination dated 8/28/22, showed the resident could make their needs known but could not make medical decisions. On 2/21/23 at 0747 hours, Resident 8 was observed lying in bed. Located on the resident's tray table were two glass bottles of liquid. One bottle was labeled Po Sum On with foreign characters on the label. The other bottle was labeled Lung Choy Shung Pain Relief Liquid 6.76 fluid ounces with foreign characters on the label. Both bottles were open and approximately half-full. Review of Resident 8's Physician Orders summary for February 2023 failed to show the physician's orders for Po Sum On and Lung Choy Shung Pain Relief Liquid. Review of Resident 8's Self-Administration assessment dated [DATE], showed Resident 8 was not able to safely self-administer medications. On 2/21/23 at 0913 hours, a telephone interview was conducted with Family Member 1. Family Member 1 stated the facility was aware of the medicated oils, and Resident 8 used the oils for pain relief and nausea. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 24 Event ID: 055671 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0554 Review of the National Library of Medicine's DailyMed (online resource of labeling for prescription and nonprescription drugs) showed the following: Level of Harm - Minimal harm or potential for actual harm -Po Sum On: Active ingredient - menthol 15%. Residents Affected - Few -Lung Choy Shung Pain Relief Liquid: Active ingredients - menthol 2.8% and camphor 2.8%. On 2/23/23 at 1111 hours, an observation, interview and concurrent medical record review was conducted with LVN 1. LVN 1 observed the Po Sum On and Lung Choy Shung Pain Relief Liquid at Resident 8's bedside and stated they were unsure of the bottles' contents. During Resident 8's medical record review, LVN 1 verified there was no physician's orders for Po Sum On and Lung Choy Shung Pain Relief Liquid. LVN 1 verified the Self-Administration Assessment showed Resident 8 was not able to safely self-administer medications. On 2/23/23 at 1326 hours, an observation and concurrent interview were conducted with the DSD/IP. The DSD/IP stated Resident 8's Po Sum On and Lung Choy Shung Pain Relief Liquid were brought in by the family a while ago. The DSD/IP verified there should be a physician's orders for their use, and the resident was determined to be not safe for self-administer medications as per the IDT. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 2 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. Medical record review for Resident 337 was initiated on 2/21/23. Resident 337 was admitted to the facility on [DATE]. Residents Affected - Few Review of Resident 337's Physician Orders for February 2023 showed an order dated 2/20/23, for fluid restriction 1500 ml per day, with the breakdown as dietary to provide 870 ml (breakfast 290 ml, lunch 290 ml, and dinner 290 ml) and nursing to provide 630 ml as follows: 120 ml for 11-7 shift, 340 ml for 7-3 shift, and 170 ml for 3-11 shift. On 2/23/23 at 1103 hours, an interview and concurrent medical record review was conducted with LVN 1. LVN 1 stated the intake and output were monitored for all the residents on fluid restrictions, receiving hemodialysis, and new admissions with gastric feeding tubes (a tube inserted into the stomach for feeding/hydration.) LVN 1 verified Resident 337 was on a fluid restriction due to anasarca (form of extreme, generalized edema, which is when fluid accumulation causes a palpable swelling throughout the entire body). When asked where the resident's intake was documented, the LVN went to the binder on the medication cart and retrieved Resident 337's Intake and Output record initiated 2/18/23. Review of the Intake and Output record showed spaces for each shift (night, day, and evening shifts) to document the resident's intake. The form showed the following entries: - On 2/18/23, evening shift, Resident 337 had 240 ml of fluid intake. - There were no entries documented for 2/19, 2/20, and 2/21/23. - On 2/22/23, day shift, the resident had 340 ml of fluid intake. There were no entries for the night and evening shifts. LVN 1 stated the form should have been completed to ensure an accurate fluid restriction monitoring. 3. Review of the facility's P&P titled Blood Pressure, Measuring revised September 2010 showed when obtaining a blood pressure, to expose the resident's arm by rolling the sleeve up about five inches above the elbow. If the cuff is placed too loose, will get a false high blood pressure reading. On 2/22/23 at 0852 hours, during a Medication Administration observation, LVN 1 stated they were taking Resident 340's blood pressure prior to administering the resident's blood pressure medications. LVN 1 was observed taking Resident 340's manual blood pressure with a blood pressure cuff and stethoscope. Resident 340 was wearing a red collared, button-up house jacket. LVN 1 placed both the blood pressure cuff and stethoscope bell over the sleeve and obtained the resident's blood pressure with the results of 130/80 mmHg. LVN 1 then completed the medication administration including two blood pressure medications (metropolol tartrate 25 mg). Medical record review for Resident 340 was initiated on 2/21/23. Resident 340 was admitted to the facility on [DATE]. Review of Resident 340's physician's orders for February 2023 showed the following orders: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 3 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few - metropolol tartrate 25 mg, one tab twice a day for hypertension and hold if the SBP less than 90 mmHg or heart rate less than 50 mmHg. On 2/22/23 at 1143 hours, an interview and concurrent facility document review were conducted with LVN 1. LVN 1 stated they did not remove or push up Resident 340's sleeve when obtaining the resident's blood pressure earlier, and verified they should have. Based on interview, medical record review, and facility P&P review, the facility failed to provide the treatment and care in accordance with the professional standards of practice for one of two closed records residents (Resident 35), one of 13 final sampled residents (Resident 337), and one nonsampled resident (Resident 340). * The facility failed to notify the physician of Resident 35's change of condition as per the facility's P&P. * The facility failed to monitor Resident 337's fluid intake as ordered. * The facility failed to properly obtain Resident's 340's blood pressure measurement as per the facility's P&P. These failures had the potential for residents not to receive appropriate care and treatment. Findings: 1. Review of the facility's P&P titled Change in a Resident's Condition or Status revised February 2021 showed the facility should notify the resident, his or her attending physician, and the resident representative of changes in the resident's medical/mental condition and/or status. Closed record review for Resident 35 was initiated on 2/23/23. Resident 35 was admitted to the facility on [DATE]. Review of the POLST dated 12/1/22, showed Do Not Attempt Resuscitation/DNR (Allow Natural death). Under the section for medical intervention showed selective treatment- goal of treating medical conditions while avoiding burdensome measures, hydration pain relief only, do not transfer to hospital at all. Further review of the POLST showed to not return to the hospital and was discussed with the family. Review of the Care Plan dated 11/27/22, showed a care plan problem addressing Resident 35's end of life. The goal was to honor the resident and family's wish, and the intervention included to call the MD to report the resident's change of condition. Review of the Progress Note dated 12/14/22 at 0117 hours, showed on 12/13/22 at 2330 hours, Resident 35 was noted to have labored breathing using accessory muscles. Resident 35's oxygen saturation level was 84% with oxygen via nasal cannula at 3 liter per minute, breathing treatment was administered, and the oxygen saturation level was elevated to 90-97%. The resident remained arousable with continuous labored breathing. Resident 35's representative was notified. Further review of the progress note did not show documented evidence the physician was notified of the above change of condition. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 4 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 2/23/23 at 1609 hours, a concurrent interview and medical record review was conducted with LVN 2. LVN 2 stated the change of condition of Resident 35 was first identified on 12/13/22 at 2330 hours, when Resident 35 was noted to have labored breathing. LVN 2 stated that was a change of condition and the physician should have been notified. LVN 2 verified the physician was not notified. LVN 2 stated when Resident 35 had labored breathing, the resident's physician should have been notified immediately. On 2/23/23 at 1624 hours, a concurrent interview and medical record review was conducted with the DSD/IP. The DSD/IP verified the above findings and stated the physician should have been notified when there was a change of condition. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 5 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and medical record review, the facility failed to implement the intervention for preventing the pressure ulcer for one of 13 final sampled residents (Resident 1). This failure had the potential for Resident 1's pressure sore not improving. Residents Affected - Few Findings: On 2/21/23 at 0915, 1214, and 1413 hours, Resident 1 was observed in bed on her back. The resident was not on a special mattress. Review of the facility's matrix showed Resident 1 had developed a Stage 2 pressure ulcer on her sacrococcyx at the facility. On 2/23/23 at 1044 hours, a concurrent wound treatment and interview was conducted with LVN 2. When asked about implementing a special mattress for Resident 1's pressure ulcer, LVN 2 could not explain. Medical record review for Resident 1 was initiated on 2/21/23. Resident 1 was readmitted to the facility on [DATE]. Review of Resident 1's History and Physical Examination showed Resident 1 had diagnoses including dementia and general weakness. Review of Resident 1's Skin Inspection Report showed Resident 1's skin was not intact on 11/29/22, and the resident was known to refuse repositioning and was combative when staff tried to get close to her. Review of Resident 1's Wound Assessment Report dated 1/8/23, showed Resident 1's sacrococcyx pressure ulcer had deteriorated. Review of Resident 1's plan of care addressing the resident's risk for impaired skin integrity dated 11/1/22, showed the interventions included providing the pressure relieving mattress. On 02/23/23 at 1142 hours, the DSD/IP verified the above findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 6 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 2. On 02/23/23 at 1041 hours, an observation of Resident 1 and concurrent interview was conducted with CNA 1. CNA 1 verified Resident 1 had contractures to her right hand. On 02/23/23 at 1044 hours, an observation of Resident 1 and concurrent interview was conducted with LVN 2. LVN 2 verified Resident 1 had bilateral foot drop. Medical record review for Resident 1 was initiated on 2/21/23. Review of Resident 1's History and Physical Examination dated November 2022 showed a diagnosis of contractures. Review of Resident 1's Physician Order Summary showed an order dated 11/1/22, to provide passive ROM exercises to Resident 1's bilateral upper and lower extremities five times weekly; and apply Resident 1's handroll for four hours, five times weekly. Review of Resident 1's quarterly MDS dated [DATE], showed Resident 1 was totally dependent on staff for her ADL care. Review of Resident 1's documentation for RNA services from 2/10 to 2/23/23, showed no documented evidence passive ROM exercises were not provided as ordered by the physician. Resident 1 was provided with ROM exercises on 2/10, 2/14, and 2/16/23, instead of five times weekly as per the physician's order. Review of Resident 1's documentation for RNA services from 2/10 to 2/23/23, showed no documented evidence handroll was not applied as ordered by the physician. The document showed Resident's 1 handroll was applied only on 2/10, 2/14, and 2/16/23, instead of five times weekly as per the physician's order. On 2/23/23 at 1002 hours, an interview with the DSD/IP was conducted. The DSD/IP was informed and verified the above findings. Cross reference to F686. Based on observation, interview, medical record review, and facility P&P review, the facility failed to provide RNA services to two of 13 final sampled residents (Residents 1 and 9) as ordered by the physician. This failure had the potential to result in the resident's decline in ROM and deterioration in their ability to perform ADL care. Findings: Review of the facility's P&P titled Restorative Nursing Services revised July 2017 showed the residents would receive restorative nursing care as needed to help promote optimal safety and independence. On 2/21/23 at 1236 hours, Resident 9 was observed lying in the bed. Resident 1's right hand was in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 7 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0688 a flexed position. There was no splint on the right hand. Level of Harm - Minimal harm or potential for actual harm Record review for Resident 9 was initiated on 2/22/23. Resident 9 was admitted to the facility on [DATE]. Residents Affected - Few Review of the MDS dated [DATE], showed the ROM functions were impaired on one side of the upper extremity and one side of the lower extremity. Review of the Resident 9's Care Plan dated 8/21/22, showed a care plan problem addressing the impaired physical mobility. The goal was to maintain highest level of mobility possible and the intervention included to provide RNA services as ordered. Review of the Physician Order Summary for February 2023 showed an order dated 9/25/22, to provide the following: - RNA to apply the right elbow orthosis everyday five times a week for up to six hours as tolerated - RNA to apply the right wrist/hand orthosis everyday five times a week for up to six hours as tolerated - RNA to apply the hip abductor orthosis everyday five times a week for up to six hours as tolerated - RNA to apply the PRAFO everyday five times a week up to six hours as tolerated - RNA to apply the knee orthosis everyday five times a week for up to six hours as tolerated - RNA to perform AA/PROM exercise, to the left upper and lower extremities everyday five times a week - RNA to perform PROM exercise to the right upper and lower extremities everyday five times a week. Review of the documentation for RNA services from 2/8 to 2/22/23, showed RNA services were provided only on the following days: - Passive ROM exercises on 2/9/23 at 0800 and 1127 hours, 2/10/23 at 0800 hours, 2/14/23 at 0800 hours, and 2/16/23 at 0800 hours. - Splint brace assistance on 2/9/23 at 0800 and 1127 hours, 2/10/23 at 0800 hours, 2/14/23 at 0800 hours, and 2/16/23 at 0800 hours. However, there was no documented evidence to explain why RNA services were not provided as ordered by the physician. On 2/22/23, at 1514 hours, an interview and concurrent medical record review was conducted with the DSD/IP. The DSD/IP verified Resident 9 did not receive RNA services as ordered by the physician. The DSD/IP stated the facility had shortage of RNA and she was looking for a staff to provide RNA services to the residents. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 8 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 observation, interview, medical record and facility P&P review, the facility failed to implement the safety interventions and provided supervision to one of 13 final sampled residents (Resident 26) who smoked. This put Resident 26 at risk for injury while smoking. Findings: Review of the facility's P&P titled Smoking Policy - Residents revised July 2017 showed the residents will be evaluated on admission to determine if they have the ability to smoke safely with or without supervision. Any resident who have restricted smoking privilege which required monitoring shall have direct supervision of a staff, family, visitor or volunteer worker at all times while smoking. Medical record review for Resident 26 was initiated on 2/21/23. Resident 26 was admitted to the facility on [DATE]. Review of Resident 26's Safe Smoking assessment dated [DATE], showed the IDT determined Resident 26 was an unsafe smoker and required constant supervision while smoking. Review of Resident 26's Care Plan showed a care plan problem initiated 10/23/22, addressing potential safety deficit and at increased risk for injury related to cognitive and visual deficits. The interventions included to provide direct staff supervision while smoking at all times and for the resident's lighter to be stored in the medication cart. On 2/21/23 at 0953 hours, an interview was conducted with Resident 26 while at the designated smoking area. Resident 26 stated he would smoke after every meal. When asked what he needed to do if wanting to smoke, the resident stated he would get his cigarette from the nurse, come out to the smoking area, and put on a smoking apron (fire retardant material). Resident 26 stated he would light his own cigarette; however, he was supervised while smoking. On 2/21/23 at 1237 hours, Resident 26 was observed smoking a cigarette in the designated smoking area. However, there was no staff, volunteer, or family monitoring the resident while smoking as per the facility's P&P. On 2/22/23 at 0841 hours, Resident 26 was observed going out to the smoking area. Resident 26 donned on a safety apron and lighted his cigarette with a lighter. However, there was no staff, volunteer, or family monitoring the resident while smoking. On 2/22/23 at 1135 hours, LVN 1 was asked about Resident 26's smoking materials. LVN 1 stated the residents' cigarettes and lighters should be locked up in the medication cart. LVN 1 retrieved a plastic bag with packs of cigarettes; however, there was no lighter in the bag. LVN 1 walked over to Resident 26's room and retrieved the lighter from the resident. On 2/22/23 at 1246 hours, Resident 26 was observed asking LVN 1 for a cigarette and the lighter. LVN 1 unlocked the medication cart and gave the items to the resident. Resident 26 made his way down the hallway. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 9 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 On 2/22/23 at 1249 hours, Resident 26 was observed at the smoking area with an apron and lit his cigarette and began smoking. However, there was no staff, volunteer, or family monitoring the resident while smoking. On 2/22/23 at 1250 hours, an interview was conducted with LVN 1. LVN 1 stated Resident 26 was able to smoke unsupervised; however, they could check on the resident occasionally. LVN further stated they would check on him in a bit. On 2/22/23 at 1253 hours, LVN 1 was observed going to the smoking area, spoke to Resident 26 briefly, and went back into the facility. Resident 26 continued smoking without supervision. On 2/22/23 at 1313 hours, an interview and concurrent medical record review was conducted. LVN 1 was asked to locate Resident 26's smoking assessment; however, LVN 1 was unable to locate one in the resident's medical record. When asked what precautions were in place for the resident, LVN stated the staff needed to ensure he would return the lighter and store his cigarettes. LVN 1 reviewed Resident 26's care plan and verified the resident's care plan showed to provide direct staff supervision while smoking at all times and for the lighter to be stored in the medication cart. LVN 1 verified Resident 26 had not been supervised at all times while smoking, and the lighter was observed earlier being in the resident's possession. On 2/22/23 at 1322 hours, a follow-up interview and concurrent medical record review was conducted with LVN 1. LVN 1 stated they were able to locate the Safe Smoking Assessment and verified Resident 26 was determined to be an unsafe smoker and required constant supervision while smoking. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 10 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility document review, the facility failed to ensure proper monitoring and documentation for two of two residents (Residents 8 and 14) receiving hemodialysis services. This failure had the potential to delay identifying and responding to dialysis access site issues for the residents. Residents Affected - Few Findings: Review of the facility's P&P titled End-Stage Renal Disease, Care of a Resident revised September 2010 showed the nurse will document the catheter location and condition of dressing, and interventions if needed every shift. 1. Medical record review for Resident 8 was initiated on 2/21/23. Resident 8 was admitted to the facility on [DATE]. Review of Resident 8's Physician Orders for February 2023 showed an order dated 8/26/22, for dialysis services to be provided off-site every Tuesday, Thursday, and Saturday. Review of Resident 8's Care Plan initiated on 8/27/22, showed a care plan problem addressing the resident's AV/Shunt Graph secondary to end stage renal disease, AV shunt to the left upper arm. The interventions included to check the resident's shunt for bruit and thrill every shift and monitor for signs of redness, infections, and draining. Review of Resident 8's Dialysis Assessment sheets for February 2023, showed the resident's dialysis device and site were assessed on the following dates: - On 2/21/23, for the day and evening shifts (two of three shifts). - On 2/18/23, for the day and evening shifts (two of three shifts). - On 2/16/23, for the day and evening shifts (two of three shifts). - On 2/14/23, for the day and evening shifts (two of three shifts). - On 2/11/23, for the day and evening shifts (two of three shifts). - On 2/9/23, for the day and evening shifts (two of three shifts). - On 2/7/23, for the day and evening shifts (two of three shifts). - On 2/4/23, for the day and evening shifts (two of three shifts). - On 2/2/23, for the day and evening shifts (two of three shifts). Review of Resident 8's Department Notes for February 2023 showed the resident's dialysis access site/dressing were documented on the following additional shifts: (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 11 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0698 - On 2/19/23 at 0017 hours (night shift) Level of Harm - Minimal harm or potential for actual harm - On 2/5/23 at 246 hours (day shift) Residents Affected - Few On 2/23/23 at 1111 hours, an interview and concurrent document review was conducted with LVN 1. LVN 1 stated the protocol was to monitor and document the dialysis access site and dressing on dialysis days using the Dialysis Assessment sheets. LVN 1 reviewed the facility's P&P and resident's medical record and verified Resident 8's access site and dressing assessments were not documented on every shift, and should have been. On 2/23/23 at 1154 hours, a follow-up interview and record review were conducted with LVN 1. LVN 1 verified Resident 8's care plan showed to check the resident's shunt for bruit and thrill every shift and monitor for signs of redness, infections, and draining. 2. Medical record review for Resident 14 was initiated on 2/21/23. Resident 14 was readmitted to the facility on [DATE]. Review of Resident 14's Physician Orders for February 2023 showed an order dated 2/28/22, for dialysis services to be provided off-site every Tuesday, Thursday, and Saturday. Review of Resident 14's Care Plan initiated on 8/29/22, showed a care plan problem addressing the resident's AV/Shunt Graph secondary to end stage renal disease, AV shunt to left upper arm . The interventions included to check the resident's shunt for bruit and thrill every shift. Review of Resident 14's Dialysis Assessment sheets for February 2023, showed the resident dialysis device and site were assessed on the following dates: - On 2/21/23, for all three shifts. - On 2/18/23, for all three shifts. - On 2/16/23, for all three shifts. - On 2/14/23, for all three shifts. - On 2/11/23, for all three shifts. - On 2/9/23, for all three shifts. - On 2/7/23, for all three shifts. - On 2/4/23, for all three shifts. - On 2/2/23, for all three shifts. Review of Resident 14's Department Notes for February 2023 failed to show documented evidence of the resident's dialysis access site, dressing, bruit and thrill documentation on non-dialysis days for all shifts. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 12 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete On 2/23/23 at 1419 hours, an interview and concurrent record review were conducted with LVN 2. LVN 2 stated the resident's dialysis site was monitored after returning from dialysis. LVN 2 reviewed Resident 14's care plan and verified the care plan showed to monitor the site and check for a bruit and thrill every shift. LVN 2 stated the nursing staff monitored the resident's dialysis access site every shift, but only documented if there was a change of condition. LVN 2 then reviewed the facility's P&P and verified the P&P showed to document the monitoring of the access site every shift. LVN 2 reviewed Resident 14's medical record and verified there was no documentation to show Resident 14's dialysis access site, bruit, thrill, and dressing were assessed every shift. Event ID: Facility ID: 055671 If continuation sheet Page 13 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0755 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, medical record review, and facility document review, the facility failed to follow physician orders for one nonsampled resident (Resident 13). * Resident 13 was administered ibuprofen witout food. This posed the risk for the resident to have stomach upset or nausea/vomiting post medication administration. Findings: On 2/22/23 at 0932 hours, a medication administration observation was conducted with LVN 2. LVN 2 went to Resident 13's bedside prior to the task, and Resident 13 stated they did not want specific medications due to their stomach being a little upset, in addition to refusing her eye drops. LVN 2 clarified with the resident would not be administered the resident's scheduled vitamin C, Miralax and lactulose and artificial tears, then retrieved and administered the following medications with water: - multivitamin with minerals (vitamin and mineral supplement) - vitamin B complex (vitamin supplement) - fludrocortisone 0.1 mg (a medication used for low blood pressure) - ferrous sulfate 325 mg (an iron supplement) - vitamin D 3 4000 iu (vitamin supplement) - albuterol two puffs, inhalation - ibuprofen 600 mg (non-steroidal anti inflammatory used for pain) - acidophilus one capsule (dietary supplement) - Klonipin 1 mg (sedative) Medical record review for Resident 13 was initiated on 2/22/23. Resident 13 was admitted to the facility on [DATE]. Review of Resident 13's physician orders summary for February 2023 showed an order dated 5/24/22, for ibuprofen (for pain) 600 mg three times a day, take with food. On 2/22/23 at 1031 hours, an interview was conducted with LVN 2. LVN 2 stated they did not provide food with the ibuprofen medication since the Resident 13 just had breakfast. When asked how much and what time the resident finished breakfast, LVN 2 stated she would ask the CNA. On 2/22/23, LVN 2 asked CNA 1 how much breakfast Resident 13 had, and CNA 1 stated 80% and the resident finished breakfast around 0810 hours. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 14 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0755 Level of Harm - Minimal harm or potential for actual harm On 2/22/23 at 1209 hours, a telephone interview was conducted with the Pharmacy Consultant. The Pharmacy Consultant stated ibuprofen could cause gastric irritation and should be taken with food or a snack when being administered to prevent stomach upset and or nausea/vomiting. The consultant stated it was preferable to administer ibuprofen with or take closely with a meal, but up to an hour after a meal would be fine, but not more. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 15 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 the food was kept free of exposure to chemicals. Residents Affected - Some * The vent hood stove in the kitchen had peeling paint. This had the potential for food-borne illnesses. Findings: Review of the CMS 672 Resident Census and Conditions of Residents showed the facility cooked food in the facility kitchen for a total of 32 of 36 residents. On 2/21/23, at 0735 hours, during an initial tour of the facility's kitchen, a concurrent observation and interview was conducted with [NAME] 1, the Dietary Manager, and Maintenance Director. The vent hood's border located above the stove was observed to have areas of peeling black substance. Also, areas of bubbling black substance were observed. On 2/23/23, at 0920 hours an interview with the Maintenance Director was conducted. The Maintenance Director verified the black peeling substance observed on the facility's vent hood was paint. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 16 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0842 Level of Harm - Potential for minimal harm Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on observation, interview, and facility document review, the facility failed to protect the resident identifiable information. Residents Affected - Some * The facility's survey results binder for public viewing included thirteen confidential resident rosters. This failure had the potential to result in confidential resident information being accessible to the public. Findings: On 2/22/23 at 1054 hours, the facility's survey results binder labeled Department of Health Services Annual Survey was observed located in a wall file pocket between two resident rooms, across from the Nurses' Station for public view. Review of the survey binder included thirteen Confidential Resident Rosters (a list which identified the names of the residents by their identifiers given during survey) for the following surveys: - An abbreviated survey completed on 4/22/19, with six resident names and their identifiers. - An abbreviated survey completed on 5/1/19, with two resident names and their identifiers. - A COVID-19 Mitigation Plan and Infection Control survey completed on 7/21/20, with three resident names and their identifiers. - An abbreviated survey completed on 8/24/20, with two resident names and their identifiers. - An abbreviated survey completed on 10/23/20, with five resident names and their identifiers. - An abbreviated survey completed on 12/23/20, with two resident names and their identifiers. - An abbreviated survey completed on 1/19/21, with two resident names and their identifiers. - An abbreviated survey completed on 3/15/21, with two resident names and their identifiers. - An abbreviated survey completed on 4/19/21, with three resident names and their identifiers. - An abbreviated survey completed on 6/3/21, with two resident names and their identifiers. - An abbreviated survey completed on 9/8/21, with two resident names and their identifiers. - An abbreviated survey completed on 9/14/21, with three resident names and their identifiers. - An abbreviated survey completed on 9/23/21, with one resident name and their identifier. On 2/22/23 at 1115 hours, an interview and concurrent facility document review was conducted with the Administrator. The Administrator stated the DON and Administrator were responsible for placing the survey results in the binder. The Administer reviewed the confidential resident rosters and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 17 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0842 verified the rosters should not be located in the binder. Level of Harm - Potential for minimal harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 18 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 observation, interview, medical record review, and facility P&P review, the facility failed to maintain an infection control program designed to provide a safe and sanitary environment and help prevent the development and transmission of diseases and infections for two of 13 final sampled residents (Residents 11 and 30 ) and five nonsampled residents (Residents 3, 5, 13, 17, and 340). Residents Affected - Some * Resident 1's bolster was ripped exposing the inner foam. * Resident 5's eyedrops were instilled without proper hand hygiene. * The blood pressure monitoring device was not properly cleaned and was used for Residents 13, 20, 30, and 340. * Resident 340's medication was administered with a potentially contaminated utensil. * The facility failed to provide appropriate infection surveillance when Residents 3, 11, 17, and 30's HAIs were categorized as CAIs. These failures had the potential to result in the spread of infection to the vulnerable population. 1. On 2/21/23 at 915 hours, concurrent observation and interview was conducted with Laundry Staff 1. Laundry Staff 1 verified the left side of Resident 1's bolster was ripped, exposing the inner foam. 2. Review of the facility's P&P titled Instillation of Eye Drops revised date January 2014 showed when both eyes require eye drops, perform hand hygiene before treating each eye. On 2/22/23 at 1235 hours, a medication administration observation for Resident 5 was conducted with LVN 1. LVN 1 was observed performing hand hygiene, donning gloves, and instilling artificial tears to Resident 5's right eye, then the left eye. LVN 1 failed to remove their gloves and perform hand hygiene after instilling the drops to the right eye and before instilling them into the left eye. On 2/22/23 at 1312 hours, an interview and concurrent facility document review was conducted with LVN 1. LVN reviewed the facility's P&P and verified they failed to perform hand hygiene before instilling eye drops into the resident's left eye. 3. Review of the facility's P&P titled Cleaning and Disinfecting of Resident-Care Items and Equipment revised October 2018 showed reusable items are cleaned and disinfected between residents. On 2/22/23 at 0852 hours, during a medication administration observation, LVN 1 was observed taking Resident 340's blood pressure manually. After completing the task, LVN 1 cleaned the blood pressure cuff with Lysol disinfecting wipes and placed the cuff back in the medication cart. On 2/22/23 at 0919 hours, during a medication administration observation, LVN 2 was observed cleaning a wrist blood pressure monitoring device with Lysol disinfecting wipes prior to obtaining (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 19 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 Resident 30's blood pressure. Level of Harm - Minimal harm or potential for actual harm On 2/22/23 at 0930 hours, during a medication administration observation, LVN 2 was observed cleaning a wrist blood pressure monitoring device with Lysol disinfecting wipes prior to obtaining Resident 13's blood pressure. Residents Affected - Some Review of the Lysol Disinfecting wipe packaging label showed for use on hard non-porous surfaces. On 2/22/23 at 1128 hours, an observation and concurrent interview were conducted with LVN 2. LVN 2 stated they used Lysol disinfecting wipes to disinfect the wrist blood pressure monitoring device. LVN 2 checked the wipe packaging and verified the label showing for use on hard non-porous surfaces and the wipe was not appropriate for disinfecting the wrist blood pressure monitoring device. On 2/22/23 at 1129 hours, an observation and concurrent interview were conducted with LVN 1. LVN 1 stated they used Lysol disinfecting wipes to disinfect the blood pressure cuff. LVN 1 checked the wipe packaging and verified the label showing for use on hard non-porous surfaces and the wipe was not appropriate for disinfecting the blood pressure cuff. 4. On 2/22/23 at 0905 hours, during a medication administration observation, LVN 1 was observed using a disposable spoon to administer the medication tablets into Resident 340's mouth followed by sips of water. When the resident's cup was empty, LVN 1 set the spoon down on the resident's tray table and poured ore water into the resident's cup. LVN 1 proceeded to pick up the spoon and used it to administer the medication into the resident's mouth. LVN 1 was not observed cleaning the tray table prior to setting down the spoon. On 2/22/23 at 0913 hours, LVN verified the tray table was not cleaned prior to setting the spoon down, it should be considered as contaminated. 5. Review of the facility's P&P titled Surveillance for Infection revised September 2017 showed the purpose of the surveillance of infection is to identify both individual cases and trends of epidemiologically significant organism and Healthcare Associated Infection, to guide appropriate interventions and to prevent future infections. Review of the facility's document titled Infection Prevention and Control Surveillance Log dated 1/31/23, showed the following: - Resident 30 was admitted to the facility on [DATE]. Resident 30 had infection in the urine with symptoms of confusion, foul order urine, and supra pubic pain with the onset date of 1/2/23, and was marked yes on community acquired infection (CAI). - Resident 3 was admitted to the facility on [DATE]. Resident 3 had sign and symptoms of infection, redness warmth swelling tenderness to the left lower extremity with onset date of 1/4/23, and was marked yes on CAI. - Resident 17 was admitted to the facility on [DATE]. Resident 17 had symptoms of runny nose productive cough, desaturation, sleepy body aches, and poor appetite, with onset date of 1/5/2023, and was marked yes on CAI. - Resident 11 was admitted to the facility on [DATE]. Resident 11 had symptoms of nasal congestion (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 20 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 and dry cough, with onset date of 1/13/23, and was marked yes on CAI. Level of Harm - Minimal harm or potential for actual harm On 2/24/23 at 0930 hours, a concurrent interview and record review was conducted with the DSD/IP. The DSD/IP verified the onset dates of infection for Residents 3, 11, 17, and 30 were more than three days after the admission. She stated for the above residents, their infection should have been marked as HAI, not CAI or community acquired infection. Residents Affected - Some The DSD/IP stated the purpose of the surveillance log was to monitor infection in the facility. She stated the wrong entry in surveillance log could impact identification of infection in the facility. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 21 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0908 Keep all essential equipment working safely. Level of Harm - Potential for minimal harm Based on observations and interview, the facility failed to maintain one sampled resident's (Resident 11) personal refrigerator in safe operating condition. Residents Affected - Some * The refrigerator's frozen storage area had ice buildup. This had the potential for the foods stored in this area not being kept at the proper temperature. Findings: On 2/21/23, at 0750 hours, during the initial tour of the facility, concurrent observation and interview was conducted with the Dietary Manager. Resident 11's personal refrigerator was observed with ice buildup in the frozen storage area. The Dietary Manager verified the above findings. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 22 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0911 Level of Harm - Potential for minimal harm Residents Affected - Some Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents. Based on observation, interview, and facility document review, the facility failed to ensure Room A did not accommodate more than four residents. At the time of survey, there were five beds in the room, which posed the risk of five residents sharing one room. Findings: On 2/21/23 at 0945 hours, an initial tour of the facility was conducted. Observation of Room A showed a five-bed room occupied by five residents. On 2/21/23 at 1030 hours, an interview was conducted with the Administrator. The Administrator verified there were five residents in Room A. When asked if Room A had less square footage than required, the Administrator stated yes. The Administrator verbalized the facility would like to continue with the room variance waiver for Room A. Cross reference to F912. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 23 of 24 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 055671 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/24/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Parkview Healthcare Center 1514 E. Lincoln Avenue Anaheim, CA 92805 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 0912 Level of Harm - Potential for minimal harm Residents Affected - Some Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms. Based on observation, interview, and facility document review, the facility failed to ensure Room A measured at least 80 square feet per resident. Room A was a five-bed room, which measured 78.4 feet per resident if all of the beds were filled. At the time of the survey, the room was occupied by five residents. Failure to have the designated square footage created the potential to negatively impact the residents' quality of life. Findings: On 2/21/23 at 0945 hours, an initial tour of the facility was conducted. Observation of Room A showed a five-bed room occupied by five residents. The Maintenance Director measured Room A. Measurement of the length of the room showed it was 342 feet. Measurement of the width of the room showed it was 170 feet. The combined total measurement of the room was 58140 square feet. These measurements showed the residents had 78.4 square feet of space per person in the bedroom. On 2/21/23 at 1030 hours, an interview was conducted with the Administrator. When asked if Room A had less square footage than required, the Administrator stated yes. When asked if Room A had less square footage than required, the Administrator stated yes. The Administrator verbalized the facility would like to continue with the room variance waiver for Room A. Cross reference to F911. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055671 If continuation sheet Page 24 of 24

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Citations

13 citations recorded^*CMS

What do CMS severity letters mean?

Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.

General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.

Each letter combines severity with scope: how many residents the deficiency affected.

0554GeneralS&S Dpotential for harm
F554 - The right to self-administer medications if the interdisciplinary team, as
Allow residents to self-administer drugs if determined clinically appropriate.
0684GeneralS&S Dpotential for harm
F684 - Quality of care
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
0686GeneralS&S Dpotential for harm
F686 - Skin Integrity
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
0688GeneralS&S Dpotential for harm
F688 - Mobility
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
0689GeneralS&S Dpotential for harm
F689 - Accidents
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
0698GeneralS&S Dpotential for harm
F698 - Dialysis
Provide safe, appropriate dialysis care/services for a resident who requires such services.
0755GeneralS&S Dpotential for harm
F755 - Pharmacy Services
Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
0812GeneralS&S Epotential for harm
F812 - Food safety requirements
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
0842GeneralS&S Bno actual harm
F842 - Resident-identifiable information
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
0880GeneralS&S Epotential for harm
F880 - Infection Control
Provide and implement an infection prevention and control program.
0908GeneralS&S Bno actual harm
F908 - Maintain all mechanical, electrical, and patient care equipment in safe
Keep all essential equipment working safely.
0911GeneralS&S Bno actual harm
F911 - Accommodate no more than four residents
Ensure resident rooms hold no more than 4 residents; for new construction after November 28, 2016, rooms hold no more than 2 residents.
0912GeneralS&S Bno actual harm
F912 - Measure at least 80 square feet per resident in multiple resident
Provide rooms that are at least 80 square feet per resident in multiple rooms and 100 square feet for single resident rooms.

FAQ · About this visit

Common questions about this visit

What happened during the February 24, 2023 survey of PARKVIEW HEALTHCARE CENTER?

This was a inspection survey of PARKVIEW HEALTHCARE CENTER on February 24, 2023. The surveyor cited 13 deficiencies, recorded on the federal Form 2567 statement of deficiencies.

Were any deficiencies cited at PARKVIEW HEALTHCARE CENTER on February 24, 2023?

Yes, 13 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Allow residents to self-administer drugs if determined clinically appropriate."

What type of survey was this?

This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.

SourceView on CMS Care Compare

Next steps

Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.

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Data from CMS Care Compare public records. Dataset last refreshed June 15, 2026. If you believe any information is inaccurate, report it here.

Health inspection·February 24, 2023