Health inspection·August 18, 2023

F 0578 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few were called and arrived at the facility at 10:40 AM. The Progress Notes indicated the resident was moved to the bed to begin chest compressions (the act of applying pressure to someone's chest to help blood flow through the heart in an emergency). The Progress Notes indicated at 10:50 AM, Resident 1 expired. A review of Resident 1's paramedics report dated [DATE] timed at 10:37 AM, indicated a dispatch complaint of cardiac arrest. The Disposition indicated CPR attempted and terminated or DNR. The report indicated the paramedics arrived at the facility timed at 10:44 AM. The report indicated Resident 1's cardiac arrest happened before Emergency Medical Services' (EMS) arrival. The report indicated the EMS time of assessment was at 10:45 AM and the assessment included apnea (absence of breathing), unresponsive, pale skin, bilateral eyes were fixed and dilated. The report indicated Resident 1's date and time of death was [DATE] at 10:50 AM. The report narrative indicated that while CPR and ventilations were being performed, the facility staff provided a DNR (Resident 1's unsigned POLST document) and then, Resident 1's family arrived (Family 1). The report indicated Family 1 decided she did not want resuscitation efforts continued. During a concurrent interview and record review of Resident 1's POLST at [DATE] at 3:24 PM, dated [DATE], indicated the physician did not sign Resident 1's POLST. The Director of Nursing (DON) stated it is important to have the POLST signed for completeness by the resident or legally recognized healthcare decision maker, and by the physician, because it can cause confusion if the POLST was not signed. The DON also stated it should be signed by the physician as soon as possible. A review of the facility's Policy and Procedure titled Physician Orders for Life Sustaining Treatment (POLST), revised 12/2009, indicated the admitting nurse will note the existence of the POLST form on the admission assessment and review the form for completeness. Policy also indicated a completed, fully executed POLST is a legal physician order, and is immediately actionable. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055706 If continuation sheet Page 2 of 9 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 055706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Orchard - Post Acute Care 12385 E. Washington Blvd Whittier, CA 90606 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 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. 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 record review, the facility failed to ensure that assistance with resident's call lights were provided for 4 of 5 residents (Residents 2, 3, 4 and 5) within a timely manner and according to the resident's assessed needs, ADL (Activities for Daily Living) care plans, and facility policy on Nursing Clinical - Responding to call light. Residents Affected - Some These deficient practices had the potential to result in ADL decline, unavoidable falls, and loss of dignity for Residents 2, 3, 4, and 5 which all stated that facility staff takes a long time to respond to residents when call lights are activated for help or staff assistance. Findings: 1. A review of Resident 2's admission Record, indicated the resident was originally admitted to the facility on [DATE] and was readmitted on [DATE] with the following diagnosis including hemiplegia (muscle weakness on one side of the body that can affect the arms, legs and facial muscles), hemiparesis (weakness or the inability to move on one side of the body) and low back pain. A review of Resident 2's MDS dated [DATE], indicated the resident was moderately impaired of cognition. The MDS indicated that Resident 2 required one-person limited assistance with bed mobility, transfer, walk in room, dressing, toilet use and personal hygiene. The MDS indicated Resident 2 was frequently incontinent (loss of bowel or bladder control) of bowel movement. A review of Resident 2's care plan titled ADL Self Care Performance Deficit dated 8/9/2023, indicated interventions that included resident requiring staff participation with personal hygiene and requiring physical assistance with transferring. 2. A review of Resident 3's admission Record, indicated the resident was admitted on [DATE] with diagnoses including hemiplegia (paralysis of one side of the body) and hemiparesis (weakness on one side of the body) of the left side and muscle weakness. A review of Resident 3's MDS, dated [DATE], indicated the resident was moderately impaired of cognition. The MDS indicated the resident required one-person extensive assistance with bed mobility, transfer, walk in room and corridor, locomotion (resident moves to and from) on unit, dressing, toilet use and personal hygiene. The MDS indicated Resident 3 was always incontinent of bladder and frequently incontinent of bowel movement. A review of Resident 3's care plan for ADL Self Care Performance Deficit, dated 8/2/2023, indicated the resident required staff participation with personal hygiene. The care plan also indicated the resident required physical assistance with transferring. A review of Resident 3's care plan for Bowel and Bladder dated 8/2/2023, indicated interventions that included facility staff to check the resident as required for incontinence. The care plan interventions also included for facility staff to assist the resident in washing, rinsing, and drying the perineum (the area between the genitals and the anus). 3. A review of Resident 4's admission Record, indicated the resident was originally admitted on [DATE] and readmitted on [DATE] with the following diagnosis of muscle weakness and osteoarthritis (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055706 If continuation sheet Page 3 of 9 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 055706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Orchard - Post Acute Care 12385 E. Washington Blvd Whittier, CA 90606 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 0677 (wear and tear arthritis and it occurs most frequently in the hands, hips and knees). Level of Harm - Minimal harm or potential for actual harm A review of Resident 4's History and Physical (H and P), dated 8/3/2023, indicated resident had the capacity to understand and make decisions. Residents Affected - Some A review of Resident 4's MDS, dated [DATE], indicated the resident's cognition was intact. The MDS indicated Resident 4 required two-person extensive assistance with bed mobility and toilet use. The MDS indicated, Resident 4 required one-person extensive assistance with transfer and dressing. A review of Resident 4's care plan for ADL Self-care Performance Deficit dated 5/26/2023, indicated the resident required one staff participation with personal hygiene and oral care. 4. A review of Resident 5's admission Record, indicated the resident was originally admitted on [DATE] and readmitted on [DATE] with diagnosis including muscle weakness and osteoarthritis. A review of Resident 5's undated H and P, indicated the resident had the capacity to understand and make decisions. A review of Resident 5's MDS, dated [DATE], indicated the resident was moderately impaired of cognition. The MDS also indicated the resident required two-person extensive assistance with bed mobility and one-person extensive assistance with dressing and toilet use. The MDS indicated the resident was frequently incontinent of bowel and bladder movements. A review of Resident 5's care plan for ADL Self-care Performance Deficit, dated 6/14/2023, indicated resident required assistance with toilet use such as to wash hands, adjust clothing, clean self, transfer onto toilet, transfer off toilet and to use the toilet. During an interview on 8/18/2023 at 12:20 PM, Resident 2 stated it would take 2 hours for the facility staff to come to her room and assist her when she pressed the call light for assistance for assistance needed for incontinent care. Resident 2 stated that facility staff does not come when she presses the call light. Resident 2 stated every time when she needed to have a bowel movement (BM), the facility staff does not come help. Resident 2 stated the facility staff leaves her soiled with BM for a long time. During an interview on 8/18/2023 at 12:37 PM, Resident 3 stated she feels uneasy and very upset when the facility staff does not attend to her promptly when she pressed her call light for assistance. Resident 3 stated facility staff never come on time to assist. It would take facility staff 30 minutes to come and help to change her. During an observation while in the facility's hallway, on 8/18/2023 at 1:10 PM, a call light from Resident 4's room was activated. During the observation, Resident 4's call light was answered by a facility staff at 1:17 PM (7 minutes). During a subsequent interview on 8/18/2023 at 1:34 PM with Resident 4, Resident 4 stated she pressed the call light. Resident 4 stated that it had been a while when she first pressed the call light and that she could not remember why she needed assistance. During an interview on 8/18/2023 at 1:41 PM, Resident 5 stated it would take a long time like 20 minutes for facility staff to answer when she pressed her call light for facility staff assistance. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055706 If continuation sheet Page 4 of 9 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 055706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Orchard - Post Acute Care 12385 E. Washington Blvd Whittier, CA 90606 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Resident 5 stated she mostly calls for staff assistance to ask for help with incontinence care like diaper change. During an interview with TN 1 on 8/18/23 at 2:20 PM, TN 1 stated, Answering the call light should only take a minute because in case of emergencies, or if the resident needs to use the restroom. TN 1 stated Seven minutes is a long time to wait for the call light to be answered. During an interview with RN 1 on 8/18/23 at 2:39 PM, RN 1 stated Answering a call light should take less than 5 minutes because it can be like a fall or anything urgent like that. A review of the facility policy titled Nursing Clinical - Responding to call light, dated 12/2016 all staff can assist in answering call lights. The policy indicated that staff would provide assistance for resident's call lights. On 8/18/2023 at 3:24 PM, during a concurrent interview and record review of the facility's policy and procedure titled Nursing Clinical - Responding to call light, dated 12/2016 with the Director of Nursing (DON), the DON stated that according to the facility's policy, all staff can assist in answering call lights and that nursing staff would provide assistance. During the policy review, the DON stated answering or responding to resident's call lights should be less than five (5) minutes in case the residents required urgent assistance such as toileting or a fall. The DON stated the timeframe for facility staff to answer resident's call lights was not included in the facility's written policy on Nursing Clinical - Responding to call light, but it should had been included in the facility policy. The DON also stated the falls on 8/6/2023 and 8/12/2023 was not reported nor was it thoroughly investigated. DON states a thorough investigation helps to prevent further occurrence of falls. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055706 If continuation sheet Page 5 of 9 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 055706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Orchard - Post Acute Care 12385 E. Washington Blvd Whittier, CA 90606 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 and record review, the facility failed to provide safety measures by assisting, and monitoring to prevent falls and injury for one of five sampled residents (Resident 1) by failing to: 1. Ensure Resident 1, who was assessed at high risk for falls was free from falls and injury when the resident fell hitting her forehead on the floor in her room on [DATE] and on [DATE], when Resident 1 slipped on her feces on the floor and fell. 2. Ensure facility staff immediately assisted Resident 1 when the resident activated the call light (communication system that link facility staff to the needs of residents) on [DATE] as indicated in the facility's policy on Responding to Call lights, and Resident 1's care plan for Risk for Falls and Actual Fall. Resident 3, (Resident 1's roommate) reported Resident 1 activated the call light and facility staff did not come in the room to assist immediately on [DATE]. These deficient practices resulted in Resident 1 losing her balance, hitting the wall, and falling onto the floor on [DATE] at 10:30 AM. Resident 1 vomited three times, then stopped responding to verbal commands (became non-responsive). 9-1-1 emergency services were called at 10:35AM by facility staff and chest compressions (the act of applying pressure to someone's chest to help blood flow through the heart in an emergency) were initiated. On [DATE] at 10:50 AM (20 minutes after Resident 1 was found on the floor), Resident 1 was pronounced dead. Cross referenced to F677 Findings: A review of Resident 1's admission Record indicated the resident was admitted to the facility on [DATE] with diagnoses that included urinary tract infection, abnormalities of gait (walking) and mobility, muscle weakness, and acute kidney failure (occurs when kidneys suddenly unable to filter waste products from the blood). A review of Resident 1's Fall Risk Evaluation (an assessment tool to evaluate how likely an individual is likely to fall), dated [DATE], indicated Resident 1 was evaluated at high risk for falls. A review of Resident 1's care plan for Activities of Daily Living (ADL) self-care Performance Deficit, dated [DATE], indicated Resident 1 required staff participation with transfers. The care plan indicated Resident 1 required staff assistance to wash hands, adjust clothing, clean self, transfer onto toilet, transfer off toilet and to use toilet. A review of Resident 1's care plan for Risk for Falls dated [DATE], indicated Resident 1 needs a safe environment. The care plan indicated the goal of Resident 1 to be free from falls and will not sustain serious injury through the review date. The interventions included for facility staff to be sure the resident's call light is within reach and encourage to encourage the resident to use the call light when calling for assistance. The interventions also included Resident 1 needing a safe environment and to ensure the floor was free from spills and clutter. A review of Resident 1's care plan Actual Fall dated [DATE], indicated to continue interventions (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055706 If continuation sheet Page 6 of 9 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 055706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Orchard - Post Acute Care 12385 E. Washington Blvd Whittier, CA 90606 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 with previous Risk for Falls care plan dated [DATE] and reeducated the resident to call for assistance whenever help is needed. A review of Resident 1's Minimum Data Set (MDS; a standardized assessment and care screening tool) dated [DATE], indicated the resident was severely impaired of cognition (thought process). The MDS indicated Resident 1 was assessed requiring one-person limited assistance (resident highly involved in activity; staff provide guided maneuvering of limbs or other non-weight-bearing support) with walking, including transfers from wheelchair to bed, vice versa, or to a standing position. The MDS indicated Resident 1 was assessed requiring extensive assistance with movement between locations inside her room, including self-sufficiency in the wheelchair. The MDS also indicated Resident 1 was occasionally incontinent (lack of involuntary control to urinate and bowel movement) of bowel and occasionally incontinent of bladder. A review of Resident 1's Progress Notes dated [DATE] timed at 10:14 AM, indicated Resident 1 was found on the floor and that Resident 1 complained of pain stating she hit her head on the floor. The Notes further indicated a bump was noted on the resident's left frontal head (forehead). A review of Resident 1's Progress Notes under Fall Committee Interdisciplinary Team (IDT) dated [DATE] at 9:47 AM, indicated on [DATE], during the morning shift, the charge nurse reported the resident bent down to pick up her cellphone when the resident fell on the floor and fell on her head. The Notes indicated Resident 1 complained of slight pain stating she (Resident 1) hit her head on the floor. The Progress Notes further indicated met and discussed Resident 1's fall incident and recommended interventions to reeducate the resident to call for assistance when help is needed, rehab (rehabilitation) department for safety training, and provide frequent visual checks every two (2) hours for 72 hours. A review of Resident 1's Progress Notes dated [DATE] at 3:21 PM, indicated Resident 1 reported waking up with blood on the pillowcase and to monitor Resident 1's right ear bleed. A review of Resident 1's Progress Notes dated [DATE] at 9:58 PM, indicated for Resident 1 to continue to be monitored from the previous fall. The Progress Notes indicated Resident 1 was reminded to use call light when needing assistance. A review of Resident 1's Progress Notes dated [DATE] timed at 3:50 PM, indicated at around 10:30 AM, authored by Licensed Vocational Nurse (LVN) 1, indicated LVN 1 was called to Resident 1's room and that Resident 3 (Resident 1's roommate) stated Resident 1 tried opening the curtain, defecated (had a bowel movement), and slipped on the feces. The Progress Notes also indicated Resident 1 had three (3) episodes of emesis (vomiting). The Notes further indicated the resident was assessed by the Registered Nurse (RN) Supervisor; alert, responsive, able to move all limbs (arms and legs). The resident then, stopped responding to verbal commands. The Progress Notes indicated that at 10:35 AM, 9-1-1 emergency services were called and arrived at the facility at 10:40 AM. The Progress Notes indicated the resident was moved to the bed to begin chest compressions (the act of applying pressure to someone's chest to help blood flow through the heart in an emergency). The Progress Notes indicated at 10:50 AM, Resident 1 expired. A review of Resident 3's admission Record, indicated the resident was admitted on [DATE] with diagnoses including hemiplegia (paralysis of one side of the body) and hemiparesis (weakness on one side of the body) of the left side and muscle weakness. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055706 If continuation sheet Page 7 of 9 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 055706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Orchard - Post Acute Care 12385 E. Washington Blvd Whittier, CA 90606 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 A review of Resident 3's MDS, dated [DATE], indicated the resident was moderately impaired of cognition. The MDS indicated Resident 3 did not have impaired communication and was able to understand others and be understood. The MDS indicated the resident required one-person extensive assistance with bed mobility, transfer, walk in room and corridor, locomotion (resident moves to and from) on unit, dressing, toilet use and personal hygiene. The MDS indicated Resident 3 was always incontinent of bladder and frequently incontinent of bowel movement. A review of Resident 3's care plan for ADL Self Care Performance Deficit, dated [DATE], indicated the resident required staff participation with personal hygiene. The care plan also indicated the resident required physical assistance with transferring. During an interview on [DATE] at 12:37 PM, Resident 3 stated she feels uneasy and very upset when the facility staff does not attend to her promptly when she pressed her call light for assistance. Resident 3 stated facility staff never come on time to assist. It would take facility staff 30 minutes to come and help to change her. During the same interview, on [DATE] at 12:37 PM, Resident 3 (Resident 1's roommate) stated her roommate (Resident 1) fell a few days ago while waiting for facility staff to assist her. Resident 3 stated on [DATE], at around 9:30 AM, she observed Resident 1 walk over to Resident 3's bedside of the room trying to open the drapes (window curtain) when Resident 1 lost her balance. Resident 3 stated she saw Resident 1 fall back against the wall and the resident slipped on the bowel movement on the floor. Resident 3 stated she recalled after Resident 1 fell hearing Resident 1 verbalized, Oh God . I pushed the button, but no one came. Resident 3 stated she also screamed and yelled for facility staff to come and assist Resident 1. Resident 3 stated Certified Nurse Assistant (CNA) 1 finally came to their room and attended to Resident 1 about an hour later around 10:30 AM. Resident 3 stated Resident 1 was bleeding from her left elbow and the treatment nurse (TN1) took care of the resident's elbow. Resident 3 stated I was yelling my head off and no one came. During the same interview, on [DATE] at 12:37 PM, Resident 3 stated she saw the licensed nurses lay Resident 1 on the bed and performed cardiopulmonary resuscitation (CPR; an emergency lifesaving procedure performed when the heart stops beating). Resident 3 stated Resident 1 died shortly after 9-1-1 emergency services arrived in their room. Resident 3 stated she was very upset because she did not know what to do because she was screaming and yelling for facility staff, and no one came to assist. During an interview on [DATE] at 2 PM, CNA 1 stated Resident 1 was supposed to be discharged home on [DATE] when the resident fell. CNA 1 stated Resident 1 had tendencies of getting up without waiting for facility staff assistance. On [DATE], CNA 1 stated she arrived in Resident 1's room at around 10:30 AM to respond to the activated call light in the room. CNA1 stated she was busy in another room attending to another resident prior to seeing Resident 1's call light. CNA1 stated she observed Resident 1 on the floor with feces on her legs. CNA1 stated it looked like Resident 1, Sat on her feces. CNA1 stated she called the charge nurse (LVN 1) and the TN 1. CNA1 stated Resident 1 was still alert and able to respond when she arrived in the room. CNA 1 stated LVN 1 asked her to clean Resident 1, but Resident 1 started vomiting on the chair. CNA 1 stated she assisted to clean the vomit off the resident when RN 1 arrived in Resident 1's room. CNA 1 stated the licensed nurses (LVN 1 and RN 1) stated they were going to call (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055706 If continuation sheet Page 8 of 9 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 055706 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE The Orchard - Post Acute Care 12385 E. Washington Blvd Whittier, CA 90606 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 9-1-1. CNA 1 then stated at around 10:34 AM, CNA1 stepped out of Resident 1's room while the licensed nurses assessed Resident 1. CNA1 stated she cleaned up Resident 1's feces off the resident's legs at around 10:43 AM, prior to the arrival of the 9-1-1 paramedics. During an interview, on [DATE] at 2:10 PM, LVN 1 stated on [DATE], when Resident 1 fell, CNA 1 called her to Resident 1's room. LVN 1 stated when LVN 1 arrived at Resident 1's room, LVN 1 saw Resident 1 on the floor with feces on her legs and on the floor. LVN 1 stated Resident 3 informed her that Resident 1 slipped on her feces. LVN 1 stated when she was assessing Resident 1, Resident 1 vomited and then after a few minutes vomited two more times. LVN 1 stated after vomiting, Resident 1 started to lose consciousness (loss of consciousness refers to a state in which an individual lacks normal awareness of self and the surrounding environment. The individual is not responsive and will not react to any activity or stimulation). During an interview with TN 1 on [DATE] at 2:20 PM, TN 1 stated, Answering the call light should only take a minute because in case of emergencies, or if the resident needs to use the restroom. During an interview with RN 1 on [DATE] at 2:39 PM, RN 1 stated Answering a call light should take less than 5 minutes because it can be like a fall or anything urgent like that. RN 1 stated that on [DATE] when Resident 1 fell, she was notified at around 10:20 AM and went to the resident's room. RN 1 stated at 10:25 AM, Resident 1 was still responding and stated, I'm ok. RN 1 stated she did not have a chance to call the physician because she had to call 9-1-1 when Resident 1 started to have nausea and vomiting and became lethargic (abnormal drowsiness, lack of energy). RN 1 stated Resident 1 was high risk for falls because the resident had previous falls. A review of the facility policy titled Nursing Clinical - Responding to call light, dated 12/2016 all staff can assist in answering call lights. The policy indicated that staff would provide assistance for resident's call lights. On [DATE] at 3:24 PM, during a concurrent interview and record review of the facility's policy and procedure titled Nursing Clinical - Responding to call light, dated 12/2016 with the Director of Nursing (DON), the DON stated that according to the facility's policy, all staff can assist in answering call lights and that nursing staff would provide assistance. During the policy review, the DON stated answering or responding to resident's call lights should be less than five (5) minutes in case the residents required urgent assistance such as toileting or a fall. The DON stated the timeframe for facility staff to answer resident's call lights was not included in the facility's written policy on Nursing Clinical - Responding to call light, but it should had been included in the facility policy. The DON also stated the falls on [DATE] and [DATE] was not thoroughly analyzed or investigated. The DON stated a thorough investigation of resident falls helps to prevent further occurrence of falls. A review of the facility's policy and procedure titled Fall Management Program dated [DATE], indicated the facility is to provide each resident with appropriate assessment and interventions to prevent falls and to minimize complications if a fall occurs. Additionally, all resident falls in the facility are analyzed and trended through the Quality Improvement Review Process to maintain a safe environment. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055706 If continuation sheet Page 9 of 9