Health inspection·May 30, 2025

F 0552 Ensure that residents are fully informed and understand their health status, care and treatments. Level of Harm - Minimal harm or potential for actual harm Based on the interview and record review, the facility did not obtain informed consent for one of the five residents (Resident 45) who was diagnosed with depression-a mood disorder characterized by persistent sadness and loss of interest that can affect daily life-and was being treated with the medication Celexa (a medication that treats depression) . Residents Affected - Few This deficient practice had the potential for Resident 45 to not be informed of the risks and benefits of Celexa. Findings: During a review of Resident 45's admission Record (Face Sheet), the admission Record indicated Resident 45 was admitted to the facility 1/28/2025 with diagnoses of paroxysmal atrial fibrillation (a rapid and irregular heartbeat), coronary artery disease (CAD, a narrowing or blockage of your coronary arteries, which supply oxygen-rich blood to your heart), and congestive heart failure (CHF, a serious condition in which the heart doesn't pump blood as efficiently as it should). During a review of Resident 45's Minimum Data Set (MDS, a resident assessment tool) dated 4/30/2025, the MDS indicated Resident 45 was cognitively (mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) intact and was taking antidepressant medication. During a review of Resident 45's Order Summary Report, the Order Summary Report indicated a physician order was placed on 2/12/2025 for Celexa Oral tablet 20 milligrams (mg, a unit of measurement), give 1 tablet by mouth one time a day for depression manifested by low interest and motivation with activities of daily living (ADLs, self-care activities). During an interview and record review on 5/30/2025 at 11:53 a.m., the Quality Assurance Nurse (QAN) stated that informed consent for Resident 45's Celexa medication was not obtained. The QAN stated that informed consent was required before starting the medication, but it was not obtained. Informed consents are important to ensure residents are aware of the medication's risks and benefits. During a review of the facility's policy and procedure (P/P) titled Use of Psychotropic Medications dated 12/2022, the P/P indicated a psychotropic medication was any drug that affects brain activities associated with mental process or behavior and include antidepressants. The P/P indicated prior to initiating a psychotropic medication, the resident, family, and/or resident representative must be informed of the risk and benefits of the medication and it was to be documented in the resident chart. Page 1 of 23 055758 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop and implement a comprehensive person-centered care plan for four out of seventeen sampled residents (Resident 10, Resident 23, Resident 44, and Resident 45) related to: 1. Resident 45's usage of Apixaban (a blood thinner medication). 2. develop and implement care plans of bowel and bladder retraining and bowel incontinent for Resident 10. 3. develop and implement care plans of bowel and bladder retraining and bowel incontinent for Resident 44. 4. develop and implement care plans of hypoglycemia [a condition in which a person's blood sugar (glucose) level is lower than normal] for Resident 23. These deficient practices could result in the Resident's needs not being met, negatively impacting their well-being, and leading to suboptimal patient outcomes. Findings: 1. During a review of Resident 45's admission Record (Face Sheet), the admission Record indicated Resident 45 was admitted to the facility 1/28/2025 with diagnoses of paroxysmal atrial fibrillation (a rapid and irregular heartbeat), coronary artery disease (CAD, a narrowing or blockage of your coronary arteries, which supply oxygen-rich blood to your heart), and congestive heart failure (CHF, a serious condition in which the heart doesn't pump blood as efficiently as it should). During a review of Resident 45's Minimum Data Set (MDS, a resident assessment tool) dated 4/30/2025, the MDS indicated Resident 45 was cognitively (mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) intact and was taking anticoagulant (blood thinning) medication. During a review of Resident 45's Order Summary Report, the Order Summary Report indicated a physician order was placed on 2/14/2025 for Apixaban Oral Tablet 5 milligrams (mg, a unit of measurement), give one tablet by mouth twice a day for CAD. During an interview and concurrent record review of Resident 45's care plans on 5/30/2025 at 11:53 a.m., the Quality Assurance Nurse (QAN) stated Resident 45 was receiving the anticoagulant medication Apixaban but Resident 45's care plan for Apixaban was not comprehensive and person-centered. The QAN stated Resident 45's care plan related to Apixaban was missing information on monitoring for side effects including bleeding. The QAN stated a comprehensive person-centered care plan for blood thinners was important because it informed the nursing staff what to monitor for and to look for any side effects and the interventions needed. 2. During a review of Resident 10's admission Record, the admission Record indicated, Resident 10 was initially admitted to the facility on [DATE] and last re-admission was on 5/27/2023 with 055758 Page 2 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some diagnoses including urinary retention (a condition in which you are unable to empty all the urine from your bladder) and multiple sclerosis (MS- a chronic, progressive disease involving damage to the nerve cells in the brain and spinal cord). During a review of Resident 10's History and Physical (H&P) , dated 5/28/2024, the H&P indicated, Resident 10 had the capacity (ability) to understand and make decisions. During a review of Resident 10's Minimum Data Set (MDS - a resident assessment tool), dated 4/1/2025, the MDS indicated Resident 10 required dependent assistance (Helper does all of the effort) from two or more staff for hygiene, dressing, bed mobility, transfer, and setup or clen-up assistance (Helper sets up or cleans up) from one staff for eating. The MDS section H (Bladder and Bowel) indicated, had no trail of a toileting program (scheduled toileting, prompted voiding, or bladder training). During a concurrent interview and record review on 5/29/2025, at 2:27 p.m., with Registered Nurse Supervisor (RNS) 1, Resident 10's Bowel and Bladder Assessment , dated 10/20/2023 was reviewed. The Bowel and Bladder Assessment indicated, Resident 10 was frequently incontinent for bladder and frequently incontinent for bowel (two or more episodes, but with one continent episode per week). The Bowel and Bladder Assessment indicated, Resident's assessment score was 10 and she was a candidate for prompted retraining. RNS 1 stated, Resident 10 should have been placed in bowel and bladder program as the assessment on 10/20/2023 and the care plan should be initiated for retraining. During a concurrent interview and record review on 5/29/2025, at 3:05 p.m., with RNS 1, Resident 10's Care Plan (CP) , dated from 10/2024 to 5/29/2025, there was no care plan for bowel incontinence and bowel and bladder retraining. RNS 1 stated, Care plan is the residents' plan of care and if it is not initiated or updated, it might delay the treatment. stated, staff should have initiated or update Estrada's care plan for bowel incontinence and retraining. 3. During a review of Resident 44's admission Record, the admission Record indicated, Resident 44 was initially admitted to the facility on [DATE] and last re-admission was on 3/31/2025 with diagnoses including Myasthenia Gravis (a rare long-term condition that causes muscle weakness) and urinary tract infection (UTI- an infection in the bladder/urinary tract). During a review of Resident 44's H&P, dated 1/10/2025, the H&P indicated, Resident 44 had the capacity (ability) to understand and make decisions. During a review of Resident 44's MDS dated [DATE], the MDS indicated Resident 44 required dependent assistance (Helper does all of the effort) from two or more staff for toilet hygiene, dressing, bed mobility, transfer, and moderate assistance (Helper dose less than half the effort) from one staff for personal hygiene. During a concurrent interview and record review on 5/29/2025, at 2:37 p.m., with RNS 1, Resident 44's MDS , dated 2/16/2025 and 4/7/2025 were reviewed. The MDS dated on 2/16/2025, indicated, Resident 44 had urine incontinence frequently and bowel incontinence frequently. The MDS dated [DATE] indicated that Resident 44 had not undergone a toileting program trial and was always continent. RNS 1 noted a change in Resident 44's condition from frequent incontinence to constant incontinence. RNS 1 stated, Resident 44 should have received bowel and bladder training before she had further declined. RNS 1 stated, the staff should have initiated and implemented the care plan for bowel and bladder retraining. 055758 Page 3 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a concurrent interview and record review on 5/29/2025, at 3:05 p.m., with RNS 1, Resident 10's Care Plan (CP) , dated from 1/9/2025 to 5/29/2025, there was no care plan for bowel incontinence and bowel and bladder retraining. stated, staff should have initiated or updated Zazueta's care plan for bowel incontinence. RNS 1stated, there was no care plan for bowel incontinence and retraining. stated, any concern with the resident should be care planned. RNS 1 stated, care plan is the resident's care of plan. RNS 1 stated, all care plan interventions should be implemented, and all interventions practiced should be in care plan. RNS 1 stated, care planning was important because the care plan ensure that the resident received the most appropriate and effective care as it planned. 4. During a review of Resident 23's admission Record, the admission Record indicated, Resident 23 was initially admitted to the facility on [DATE] and last re-admission was on 11/2/2024 with diagnoses including Diabetes Mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing) and dementia (a progressive state of decline in mental abilities). During a review of Resident 23's History and Physical (H&P) , dated 11/2/2024, the H&P indicated, Resident 23 had the capacity (ability) to understand and make decisions. During a review of Resident 23's Minimum Data Set ([MDS]-a resident assessment tool), dated 3/31/2025, the MDS indicated Resident 23 required dependent assistance (Helper does all of the effort) from two or more staff for bed mobility, transfer, hygiene, dressing, and moderate assistance (Helper does less than half the effort.) from one staff for eating. During a concurrent interview and record review on 5/29/2025, at 2:17 p.m., with RNS 1, Resident 23's Care Plan (CP) and Nurses Progress Notes (NPN) , dated from 10/2024 to 5/2025 (CP) and 10/31/2024 (NPN) were reviewed. Nurses progress Notes, dated 10/31/2024, indicated, Resident 23's blood glucose was 40 milligram per deciliter (mg/dl) on 10/31/2024 at 9:10 p.m. The Nurses Progress Notes indicated, the staff noticed Resident 23 was unresponsive around 8:56 p.m. and checked vital signs for blood pressure, respiration rate, heart rate, oxygen level. The Nurses Progress Notes indicated, Paramedic arrived at 9:03 p.m. and Blood sugar level was 40 mg/dl. The Care Plan dated from 10/2024 to 5/2025, indicated, there was no care plan for hypoglycemia. RNS 1 stated, there was no care plan for hypoglycemia. RNS 1 stated, significant event should be care planned and intervention should be implemented for each specific care plan. During an interview on May 30, 2025, at 4:08 p.m., the Director of Nursing (DON) explained that a resident's care plan is a specific plan of care that should be implemented as stated. The DON mentioned that care plan interventions need to be carried out and reevaluated. The interventions are discussed and decided upon during Interdisciplinary Team {(IDT) meetings, which involve team members from different disciplines collaborating with a common purpose to set goals, make decisions, and share resources and responsibilities}. These interventions aim to prevent recurrent events or issues. During a review of the facility's policy and procedure (P/P) titled Comprehensive Care Plans dated 12/19/2022, the P/P indicated it was the policy of the facility to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment. 055758 Page 4 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0658 Ensure services provided by the nursing facility meet professional standards of quality. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record reviews, the facility did not ensure that residents received appropriate treatment and care for hypoglycemic episodes in accordance with professional standards of practice. Specifically, for one of three sampled residents (Resident 23), the facility failed to ensure the resident consumed a meal after receiving insulin and did not monitor blood glucose levels or provide necessary treatment during the hypoglycemic episode. Residents Affected - Few This failure led to Resident 23's preventable hospitalization for further evaluation and treatment. Findings: During a review of Resident 23's admission Record, the admission Record indicated, Resident 23 was initially admitted to the facility on [DATE] and last re-admission was on 11/2/2024 with diagnoses including Diabetes Mellitus (DM-a disorder characterized by difficulty in blood sugar control and poor wound healing) and dementia (a progressive state of decline in mental abilities). During a review of Resident 23's History and Physical (H&P), dated 11/2/2024, the H&P indicated, Resident 23 had the capacity (ability) to understand and make decisions. During a review of Resident 23's Minimum Data Set ([MDS]-a resident assessment tool), dated 3/31/2025, the MDS indicated Resident 23 required dependent assistance (Helper does all of the effort) from two or more staff for bed mobility, transfer, hygiene, dressing, and moderate assistance (Helper does less than half the effort.) from one staff for eating. During a concurrent interview and record review on 5/29/2025, at 2:17 p.m., with Registered Nurse Supervisor (RNS) 1, Resident 23's Transfer Form (TF) and Nurses Progress Notes (NPN) , both dated 10/31/2024 were reviewed. Transfer Form indicated, Resident 23's blood glucose was 40 milligram per deciliter (mg/dl) on 10/31/2024 at 9:10 p.m. The Nurses Progress Notes indicated, the staff noticed Resident 23 was unresponsive around 8:56 p.m. and checked vital signs for blood pressure, respiration rate, heart rate, oxygen level. The Nurses Progress Notes indicated, Paramedic arrived at 9:03 p.m. and Blood sugar level was 40 mg/dl. RNS 1 stated, the nursing staff should have checked blood glucose level as soon as they found the resident unresponsive to rule out hypoglycemic episode. RNS 1 indicated that the staff should have consulted the primary physician for Glucagon, a medication that increases blood sugar levels, to address hypoglycemic episodes promptly and prevent delays in treatment. RNS 1 stated, staff probably forgot to check the blood glucose level until paramedics arrived. RNS 1 stated, if Resident 23 was assessed and treated earlier, the resident might not need to be transferred to General Acute Care Hospital (GACH). During a concurrent interview and record review on 5/30/2025, at 10:01 a.m., with Director of Staff Development (DSD), Resident 23's Medication Administration Record (MAR) and Documentation Survey Report (as known as Activities of Daily Living flowsheet) , both dated 10/31/2025 were reviewed. The Medication Administration Record indicated, Resident 23 received eight units of insulin (a hormone that removes excess sugar from the blood, can be produced by the body or given artificially via medication) because his blood glucose level was 302 mg/dl on 10/31/2024 at 4:30 p.m. The Documentation Survey Report (ADLs Flowsheet) indicated, Resident 23 ate zero percent of dinner on 10/31/2024 at 5 p.m. DSD stated, staff should have ensured that resident ate the meal after giving insulin to prevent 055758 Page 5 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0658 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few hypoglycemic episode. stated, staff should have contacted doctor to use Glucagon from Emergency Medication Kit (E-kit- a portable kit containing a small quantity of medications that can be dispensed when pharmacy services are not available) from medication storage room. During an interview on 5/30/2025, at 4:08 p.m., with Director of Nursing (DON), DON stated, staff should have got Glucagon prn order for emergency. DON stated, staff should have ensured the resident had eaten his meal after giving insulin to prevent hypoglycemia [a condition in which a person's blood sugar (glucose) level is lower than normal]. stated, staff should have checked blood glucose as soon as found him unresponsive, not after the paramedics arrived to treat immediately. DON stated, if the staff provided all the necessary care and treatment in timely manner, the resident might not need to be transferred to GACH. During a review of Resident 23's Order Summary Report (OSR) dated 5/29/2025, it was noted that an order to monitor for signs and symptoms of hypoglycemia including confusion, sweating, shakiness, and unresponsiveness was placed on 5/3/2025. The Order Summary Report also indicated that there was no order for Glucagon or any medication to treat hypoglycemia. During a review of Resident 23's Care Plan (CP) , dated from 10/1/2024 to 5/27/2025, the Care Plan indicated, there was no care plan for hypoglycemia. During a review of the facility's Policy and Procedure (P&P) titled, Hypoglycemia Management , revised 12/19/2022, the P&P indicated, Policy: It is the policy of this facility to ensure effective management of a resident who experiences a hypoglycemic episode .Effective management of hypoglycemia is important to ensure that the resident does not have further decline in their condition. Compliance Guidelines: 3. Residents that have a diagnosis of diabetes or on medications that could lower the blood sugar should have orders for glucose monitoring and treatment of hypoglycemia, unless otherwise ordered by the practitioner . 5.If the blood glucose reading is 70 mg/dL or below, the nurse will utilize the hypoglycemic protocol as per the practitioner's orders, with follow up blood glucoses as indicated, and notify the practitioner of the results as ordered. During a review of the facility's Policy and Procedure (P&P) titled, Nursing Care of the Resident with Diabetes Mellitus , revised 12/19/2022, the P&P indicated, Conditions Associated with Diabetes: The following complications are associated with diabetes: 3. Hypoglycemia (blood sugar below reference ranges). Signs and symptoms of hypoglycemia usually have a sudden onset and may include the following: stupor, unconsciousness and/or convulsions; and coma . Glucose monitoring: 3. Residents whose blood sugar is poorly controlled or those taking insulin may require more frequent monitoring, depending on the situation. 055758 Page 6 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure three of three sampled residents (Resident 10, Resident 44, and Resident 3) who were incontinent (unable to voluntarily control retention of urine or feces in the body) of bowel and bladder, were provided a retraining and/or toileting program to regain the resident's normal bowel and bladder function as much as possible by failing to: A. ensure Resident 10's bowel and bladder assessment was done and follow through quarterly, and Resident 10 received bowel and bladder retraining as the assessment indicated. B. Ensure Resident 44's bowel and bladder assessment was conducted upon admission, and that Resident 44 participated in the bowel and bladder retraining program. C. Ensure Resident 3 was offered a bowel and bladder training to restore as much bladder function as possible. This failure had a potential to result in Resident 10, Resident 44, and Resident 3's inability to regain control of bowel and bladder function and can lead to a loss of dignity. Findings: A. During a review of Resident 10's admission Record, the admission Record indicated, Resident 10 was initially admitted to the facility on [DATE] and last re-admission was on [DATE] with diagnoses including urinary retention (a condition in which you are unable to empty all the urine from your bladder) and multiple sclerosis (MS- a chronic, progressive disease involving damage to the nerve cells in the brain and spinal cord). During a review of Resident 10's History and Physical (H&P) , dated [DATE], the H&P indicated, Resident 10 had the capacity (ability) to understand and make decisions. During a review of Resident 10's Minimum Data Set (MDS - a resident assessment tool), dated [DATE], the MDS indicated Resident 10 required dependent assistance (Helper does all of the effort) from two or more staff for hygiene, dressing, bed mobility, transfer, and setup or clen-up assistance (Helper sets up or cleans up) from one staff for eating. The MDS section H (Bladder and Bowel) indicated, had no trail of a toileting program (scheduled toileting, prompted voiding, or bladder training). The MDS section H indicated, Resident 10 had urinary incontinent frequently (seven or more episodes of incontinence, but at least one episode of continent voiding) and bowel incontinent always. During an interview on [DATE], at 11:10 a.m., with Resident 10, in Resident 10's room, Resident 10 stated, she did not want to talk about her incontinence issue because it made her feel embarrassed. During a concurrent interview and record review on [DATE], at 2:27 p.m., with Registered Nurse Supervisor (RNS) 1, Resident 10's Bowel and Bladder Assessment , dated [DATE] and [DATE] were reviewed. The Bowel and Bladder Assessment on [DATE] showed Resident 10 was frequently incontinent for both bladder and bowel, with two or more episodes but at least one continent episode per week. The Bowel and Bladder Assessment, dated [DATE], indicated, Resident's assessment score was 10 and she was a candidate for prompted retraining. The Bowel and Bladder Assessment, dated [DATE], indicated, there was 055758 Page 7 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some no score or indication of the candidate for retaining or not. RNS 1 stated, the assessment on [DATE] was not completed and there should be the follow up assessment at least yearly. RNS 1 stated, there were no residents in retraining program and did not know why. During a review of Resident 10's Order Summary Report (OSR) , dated [DATE], the Order Summary Report indicated, there was no order for bowel and bladder retraining. During a review of Resident 10's Care Plan (CP) , dated from 10/2024 to [DATE], there was no care plan for bowel and bladder retraining. B. During a review of Resident 44's admission Record, the admission Record indicated, Resident 44 was initially admitted to the facility on [DATE] and last re-admission was on [DATE] with diagnoses including Myasthenia Gravis (a rare long-term condition that causes muscle weakness) and urinary tract infection (UTI- an infection in the bladder/urinary tract). During a review of Resident 44's H&P, dated [DATE], the H&P indicated, Resident 44 had the capacity (ability) to understand and make decisions. During a review of Resident 44's MDS), dated [DATE], the MDS indicated Resident 44 required dependent assistance (Helper does all of the effort) from two or more staff for toilet hygiene, dressing, bed mobility, transfer, and moderate assistance (Helper dose less than half the effort) from one staff for personal hygiene. During a concurrent interview and record review on [DATE], at 2:37 p.m., with RNS 1, Resident 44's MDS section H , dated [DATE] and [DATE] were reviewed. The MDS section H, dated on [DATE], indicated, Resident 44 had urine incontinence frequently and bowel incontinence frequently. The MDS section H, dated [DATE], indicated, Resident 44 had no trial of a toileting program and Resident 44 had bowel and bladder continence always. RNS 1 stated, there was a change of Resident 44's from frequent incontinence to always incontinence. RNS 1 stated, Resident 44 should have received bowel and bladder training before she had further declined. During a concurrent interview and record review on [DATE], at 2:50 p.m., with RNS 1, Resident 44's Bowel and Bladder Assessment , dated [DATE] was reviewed. The Bowel and Bladder Assessment indicated, there was no bowel and bladder score and no indication of a candidate for retraining or not. RNS 1 stated, there should be a new assessment done after change of condition noted on MDS, dated [DATE]. RNS 1 stated, it was important to provide bowel and bladder retraining program to residents to promote resident's well-being and maintain their function to prevent further decline. During an interview on [DATE], at 4:08 p.m., with Director of Nursing (DON), DON stated, the staff should screen the resident for bowel and bladder function and placed the resident in retraining program if the resident screened as a possible candidate. DON stated, retraining program was important to preserve current level of function, to prevent further decline, and to promote achieving highest functional level. DON stated, the facility currently had no one in retraining program and did not have any policy and procedure. DON stated, the facility should have the system to recognize the candidate and provided standardized retraining program. DON stated the staff were following education material as a policy. During a review of Resident 44's Order Summary Report (OSR) , dated [DATE], the Order Summary Report indicated, there was no order for bowel and bladder retraining. 055758 Page 8 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0690 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a review of Resident 44's Care Plan (CP) , dated from [DATE] to [DATE], there was no care plan for bowel and bladder retraining. c. During a review of Resident 3's admission Record, the admission Record indicated Resident 3 was originally admitted to the facility on [DATE] with a diagnosis including chronic kidney disease stage 4 (severe kidney damage), type 2 diabetes mellitus with hyperglycemia (chronic condition where blood sugars are consistently high), and hypertension (high blood pressure). During a review of Resident 3's MDS, dated 5 /4 /2025, the MDS indicated Resident 3's cognition was moderately impaired. The MDS indicated Resident 3 was dependent (resident does none of the effort to complete the activity, or the assistance of two or more helpers is required for the resident to complete the activity) with toilet hygiene, lower body dressing, putting on and taking off footwear and substantial / maximal assistance ( helper lifts or holds trunk or limbs and provides more than half the effort with upper body dressing). During a record review of Resident 3's Care Plan Report (CPR), the CPR dated [DATE] indicated a focus on bowel incontinence (inability to control bowel movements ) with a goal indicating the resident would be continent (ability to control your bowel and bladder) during daytime through the reviewing date. The intervention was to take resident to toilet at the same time each day the resident usually has a bowel movement. During a record review of Resident 3's B&B assessment form dated [DATE] Resident 3 had a score of 10 indicating she was a candidate for prompt toileting. The bowel and bladders assessments since the one dated [DATE], were incomplete, one dated [DATE] and [DATE] were both incomplete. During an interview and record review on [DATE] at 10:44 a.m., with the Director of staff development (DSD), the DSD stated Resident 3's Bowel and Bladder assessment form indicated the resident was a candidate for the bowel and bladder training program. The DSD stated when a resident is a candidate, they are placed on the DSD's task sheet, and the DSD would notify the Certified Nurse Assistant (CNA) and the Licensed Vocational Nurse (LVN) so there was a B&B program in place. The DSD stated she did not know why Resident 3 was not getting B&B training. The DSD stated because Resident 3 did not get B&B training, the resident could be at risk for skin breakdown which can also lead to a dignity issue. During an interview on [DATE] at 4:09 p.m., with the DON, the DON indicated if there has been an assessment and the resident is a candidate the facility should try B&B training for the resident. The DON stated it as important for facility staff to carry out assessments and implement. During a review of the facility's Policy and Procedure (P&P) titled, Bladder and Bowel Incontinence: A Care Solution , dated 2022, the P&P indicated, Introduction: resident experiencing incontinence may have feelings of shame, embarrassment, a loss of independence and may isolate themselves due to fear of accidents. Restorative Toileting Program: These programs are individualized, resident-centered, and communicated to the staff and resident. They must be care planned and reevaluated at least quarterly and whenever there is a change in the resident's cognition, continence, or activity of daily living (ADL) status. The use of the bladder/bowel assessment, bladder and bowel diary and bladder/bowel tool can aid the restorative nurse in determining the best program for the resident and serve as part of the documentation of the program and its progress .Care and Care Planning: Care planning for bladder and/or bowel incontinence must be resident centered and must incorporate their goals for care and updated accordingly. Care plans must take into account the results of the resident's 055758 Page 9 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0690 assessment, interventions for any reversible causes and appropriate interventions for management of incontinence. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 055758 Page 10 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0755 Level of Harm - Minimal harm or potential for actual harm Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. Based on the interview and record review, the facility did not monitor anticoagulant (blood thinning medication) usage for one out of six sampled residents (Resident 45). Residents Affected - Few This deficient practice had the potential for complications related to anticoagulant use including bleeding to go unnoticed for Resident 45. Findings: During a review of Resident 45's admission Record (Face Sheet), the admission Record indicated Resident 45 was admitted to the facility 1/28/2025 with diagnoses of paroxysmal atrial fibrillation (a rapid and irregular heartbeat), coronary artery disease (CAD, a narrowing or blockage of your coronary arteries, which supply oxygen-rich blood to your heart), and congestive heart failure (CHF, a serious condition in which the heart doesn't pump blood as efficiently as it should). During a review of Resident 45's Minimum Data Set (MDS, a resident assessment tool) dated 4/30/2025, the MDS indicated Resident 45 was cognitively (mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) intact and was taking anticoagulant (blood thinning) medication. During a review of Resident 45's Order Summary Report, the Order Summary Report indicated a physician order was placed on 2/14/2025 for Apixaban Oral Tablet 5 milligrams (mg, a unit of measurement), give one tablet by mouth twice a day for CAD. During an interview and concurrent record review of Resident 45's care plans, medication administration record (MAR), and Physician's Orders on 5/30/2025 at 11:53 a.m., the Quality Assurance Nurse (QAN) stated Resident 45 was receiving the anticoagulant medication Apixaban but Resident 45's care plan for Apixaban was not comprehensive and person-centered. The QAN stated Resident 45's care plan related to Apixaban was missing information on monitoring for side effects including bleeding. The QAN stated a comprehensive person-centered care plan for blood thinners was important because it informed the nursing staff what to monitor for and to look for any side effects and the interventions needed. The QAN stated it was important to monitor side effects of anticoagulants because the nursing staff needed to ensure there was no bleeding. The QAN stated after reviewing Resident 45's MAR and physician's orders, Resident 45 was not being monitored for anticoagulant side effects. During an interview on 5/30/2025 at 4:09 p.m., the director of nursing (DON) stated it was important to monitor the side effects of anticoagulant usage because the resident needed to be monitored for any signs of bleeding or adverse reactions to the medication. The DON stated the potential outcome of not monitoring the resident for anticoagulant side effects was the resident could be bleeding, and the nursing staff would not know. During a review of the facility's policy and procedure (P/P) titled Comprehensive Care Plans dated 12/19/2022, the P/P indicated it was the policy of the facility to develop and implement a comprehensive person-centered care plan for each resident that included measurable objectives and timeframes to meet a resident's medical, nursing, and mental and psychosocial needs that are identified in the resident's comprehensive assessment. 055758 Page 11 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0761 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, it was noted that one tube of Triamcinolone Acetonide External Cream 0.5% (used to treat rashes) belonging to Resident 26 was not labeled or dated in medication cart 1. This deficient practice had the potential for the medication to be used after it was expired. Findings: During a review of Resident 26's admission record (face sheet), the admission Record indicated Resident 26 was admitted to the facility [DATE] with diagnoses of type 2 diabetes (a long-term condition in which the body has trouble controlling blood sugar and using it for energy) and history of falling. During a review of Resident 26's Minimum Data Set (MDS, a resident assessment tool) dated [DATE], the MDS indicated Resident 26 had moderate cognitive impairment (problems with a person's ability to think, learn, remember, use judgement, and make decisions). During a review of Resident 26's Physician's Orders, an order was placed [DATE] for Triamcinolone Acetonide External Cream 0.5 % (Triamcinolone Acetonide (Topical)) Apply to Rash topically (outside the body) every 12 hours as needed for Rash. During an observation on [DATE] at 2:19 p.m., a review of medication cart 1 with licensed vocational nurse (LVN) 1 was conducted. A tube of Triamcinolone Acetonide External Cream 0.5% was found in medication cart 1 without a label indicating Resident 26's name or the date the medication was opened. During an interview on [DATE] at 4:09 p.m., the director of nurses (DON) stated the Triamcinolone Acetonide External Cream 0.5 % that was found not to be labeled or dated on [DATE] belonged to Resident 26. The DON stated that all medication carts needed labeled and dated medications. The pharmacy label should have included Resident 26's information on the medication tube. During a review of the facility's policy and procedure (P/P) titled Labeling of Medications and Biologicals dated [DATE], the P/P indicated all medications used in the facility were to be labeled and dated in accordance with state and federal regulations to facilitate consideration of precautions and safe administration of medications. The P/P indicated, labels for individual drug containers must include: The resident's name; The prescribing physician's name; The medication name (generic and/or brand name); The prescribed dose, strength, and quantity of the medication; The prescription number (if applicable); The date the drug was dispensed; appropriate instructions and precautions (such as shake well, take with meals, do not crush, special storage instructions); the expiration date when applicable; and the route of administration . The P/P indicated, medications intended for external use must be clearly identified as such and be labeled FOR EXTERNAL USE ONLY. 055758 Page 12 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Based on observations, interviews, and record reviews, it was determined that the facility did not store food in a sanitary manner, which is necessary to prevent the growth of microorganisms. These microorganisms can cause foodborne illnesses, such as those resulting from contaminated food with pathogenic bacteria, viruses, parasites, or toxins. This issue affected 47 out of the 50 residents at the facility due to the following deficiencies: A. Ensuring food items were dated, labeled, and discarded properly. B. Ensuring [NAME] (CK) 2 performed hand hygiene (washing Hands) and changed gloves between tasks during trayline (Resident's trays are assembled and check for accuracy before food is delivered to them). This failure had the potential to impact residents, resulting in exposure to pathogens and placing them at risk for foodborne illnesses. Symptoms of such illnesses include upset stomach, cramps, nausea, vomiting, diarrhea, and fever, potentially leading to serious medical complications and hospitalization. Findings: A. During a concurrent observation and interview on 5/27/2025, at 8:22 a.m., with Dietary Supervisor (DS) in dry storage, some food items were not properly dated, labeled, sealed, or discarded for the following: a. opened and used sundried tomatoes in a plastic bin with Receiving Date (RD) of 12/16/2024, no Open Date (OD), and Used By (UB) of 12/15/2025. b. fresh vegetable (Yams/sweet potatoes) in a bin with RD of 5/13/2025 and UB 11/13/2025. one of the yams was damaged with cuts and inner part was exposed to air without sealing. c. opened and used gold medal variety muffin mix in a box with RD 6/11/2024, no OD, and no UB. The manufacture recommended UB was 3/25/2025. d. opened and used Alta Dena Low-fat Cultured Buttermilk in a pack with RD of 5/20/2025, OD of 5/22/2025, and UB of 6/4/2025. DS stated, it was all dietary staff (including herself) responsibility to check all food items for labels, dates, properly stored and sealed. DS stated that these practices were necessary to ensure the food items remained in good condition, as they were consumed by the residents. DS stated, once the food items were opened, there should be different shelf life (a time limit on how long a product can be stored before it becomes unsuitable for consumption or use). DS stated, all staff should refer to Dry Storage Chart for shelf life after opening and labeled UB date on food items. DS stated that all food items should be labeled with the receiving date when delivered. Additionally, they must 055758 Page 13 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0812 have an open date and a use-by (expiration) date. Level of Harm - Minimal harm or potential for actual harm During a concurrent observation and interview on 5/27/2025, at 8:39 a.m., with DS, in the refrigerator #1, there were food items that were not dated and discarded properly, as follows: Residents Affected - Some a. opened and used pasteurized (a process in which heat is applied to foods and drinks to kill pathogens) eggs in a box with RD of 4/29/2025 and no UB. b. opened and used snap peas in a zip lock bag with RD 5/13/2025, OD 5/18/2025, and no UB DS stated, all food items should be dated, and dietary staff should follow Refrigerated Storage Chart to ensure safety of perishable items that required refrigeration. During a review of the facility's policy and procedure (P&P) titled, Dry Storage Chart, dated 2023, the P&P indicated, opened dried vegetables' shelf life was one year and keep cool airtight container, if possible, refrigerate. The P&P indicated, fresh vegetables (sweet potatoes' shelf life was two to four weeks. The P&P stated, opened muffin mix's shelf life was nine month and store in airtight container. The P&P indicated, the buttermilk should be refrigerated. During a review of the facility's policy and procedure (P&P) titled, Refrigerated Storage Chart, dated 2020, the P&P indicated, opened buttermilk's shelf life was three to five days. The P&P indicated fresh eggs' shelf life was two to three weeks and store in covered containers. The P&P indicated, peas' shelf life was three to five days. During a review of the facility's policy and procedure (P&P) titled, Date Marking for Food Safety, revised 12/19/2022, the P&P indicated, Policy: The facility adheres to a date marking system to ensure the safety of ready-to-eat, time/temperature control for safety food .Policy explanation and Compliance Guidelines for Staffing: 2. The food shall be clearly marked to indicate the date or day b which the food shall be consumed or discarded. 3. The individual opening or preparing a food shall be responsible for date marking the food at the time the food is opened or prepared. 4. The marking system shall include the date of opening, and the date the item must be consumed or discarded or may refer to the food storage charts posted as the use by dates if manufacturer expiration dates are not present, the food storage charts are the used by dates. 5. The discard date may not exceed the manufacturer's use by date, whichever is earliest. The date of opening counts as day 1. During a review of the facility's policy and procedure (P&P) titled, Food Storage, revised 8/29/2023, the P&P indicated, Policy: Any expired or outdated food products should be discarded .Procedure: All products should be inspected for safety and quality and be dated upon receipt, when open, and when prepared. Use Use-By dates on all food stored in refrigerators and use dates according to the timetable in the dry, refrigerated, and freezer storage charts. B. During a concurrent observation and interview on 5/27/2025, at 12:28 p.m., with [NAME] (CK) 2 in the kitchen, CK 2 was placing lunch plates in the lunch cart during trayline. When CK 2 completed with placing the lunch plates in the trays with station 1's lunch cart, she touched doorknob to open the door and pushed the cart to outside with gloves on. CK 2 grabbed the doorknob again to close the door. After closing the door, CK 2 did not wash her hands and did not change her gloves and touched the stations 2 resident's tray. CK 2 stated, she should have washed her hands between the tasks and touching different surfaces to prevent spreading infection and cross-contamination (the physical movement or transfer of harmful bacteria from one person, object or place to another). CK 2 stated, 055758 Page 14 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0812 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some she should have performed hand hygiene and changed her gloves between the tasks to prevent cross contamination. During an interview on 5/30/2025, at 4:08 p.m., with Director of Nursing (DON), DON stated, all staff should perform hand hygiene between tasks to prevent cross contamination and protect vulnerable residents from infections. During a review of the facility's Policy and Procedure (P&P) titled, Food Safety and Food Storage, revised 11/4/2024, the P&P indicated, Policy Explanation and Compliance Guidelines:6. Staff should wash hands prior to handling clean dishes, and shall handle them by outside surfaces. 7. Staff shall adhere to safe hygienic practices to prevent contamination of food from hands of physical objects. During a review of the facility's Policy and Procedure (P&P) titled, Hand Hygiene, revised 12/19/2022, the P&P indicated, Policy: All staff will perform proper hand hygiene procedures to prevent the spread of infection to other personnel, residents, and visitors . Policy Explanation and Compliance Guidelines: 6. a. The use of gloves does not replace hand hygiene. If your task requires gloves, perform hand hygiene prior to donning gloves, and immediately after removing gloves. 055758 Page 15 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

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, and record review the facility failed to report the outbreak (urgent emergencies accompanied by rapid efforts to save lives and prevent further cases) of corona virus- 19 (COVID-19, a highly contagious infection, caused by a virus that can easily spread from person to person) to the State Agency (CDPH, California Department of Public Health) starting on 5/14/2025 for six out of six sampled Residents (Resident 12, Resident 30, Resident 37, Resident 40, Resident 44, and Resident 45). Residents Affected - Some These deficient practices had the potential for continued spread of the COVID-19 infection to all the facility's residents and staff. Findings: 1. During a review of Resident 12's admission Record (Face Sheet), the admission Record indicated Resident 12 was admitted to the facility 1/2/2025 with diagnoses of pneumonia (infection in the lungs), and neoplasm of the prostate (prostate cancer). During a review of Resident 12's Minimum Data Set (MDS, a resident assessment tool) dated 3/13/2025, the MDS indicated Resident 12 had moderate cognitive (mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) impairment. During a review of Resident 12's Lab Results Report dated 5/14/2025, the report indicated Resident 12 tested positive for COVID-19 on 5/14/2025. 2. During a review of Resident 45's admission Record, the admission Record indicated Resident 45 was admitted to the facility 1/28/2025 with diagnoses of paroxysmal atrial fibrillation (a rapid and irregular heartbeat), coronary artery disease (CAD, a narrowing or blockage of your coronary arteries, which supply oxygen-rich blood to your heart), and congestive heart failure (CHF, a serious condition in which the heart doesn't pump blood as efficiently as it should). During a review of Resident 45's MDS dated [DATE], the MDS indicated Resident 45 was cognitively intact. During a review of Resident 45's Change of Condition (COC) assessment dated [DATE], the COC indicated Resident 45 tested positive for COVID-19 on 5/23/2025. 3. During a review of Resident 37's admission Record, the admission Record indicated Resident 37 was admitted to the facility 2/21/2025 with diagnoses of stage 4 kidney disease (severe loss of kidney function) and lupus (An illness that occurs when the immune system attacks healthy tissues and organs). During a review of Resident 37's MDS dated [DATE], the MDS indicated Resident 37 had moderate cognitive (mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) impairment. During a review of Resident 37's Lab Results Report dated 5/18/2025, the report indicated Resident 37 tested positive for COVID-19 on 5/18/2025. 055758 Page 16 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 4. During a review of Resident 30's admission Record, the admission record indicated Resident 30 was admitted to the facility 3/31/2025 with diagnoses of hypertension (high blood pressure) and neoplasm of the cecum (colon cancer). During a review of Resident of Resident 30's MDS dated [DATE], the MDS indicated Resident 30 was cognitively intact. During a review of Resident 30's Lab Results Report dated 5/14/2025, the report indicated Resident 30 tested positive for COVID-19 on 5/14/2025. 5. During a review of Resident 44's admission Record, the admission Record indicated Resident 44 was admitted to the facility on [DATE] with diagnoses of bronchitis (Inflammation of the lining of bronchial tubes (carry air to and from the lungs)) and morbid obesity (overweight). During a review of Resident 44's MDS dated [DATE], the MDS indicated Resident 44 had moderate cognitive impairment. During a review of Resident 44's Lab Results Report dated 5/14/2025, the report indicated Resident 44 tested positive for COVID-19 on 5/14/2025. 6. During a review of Resident 40's admission Record, the admission Record indicated Resident 40 was admitted to the facility 4/23/2025 with diagnoses of hyponatremia (low salt). During a review of Resident 40's MDS dated [DATE], the MDS indicated Resident 40 had moderate cognitive impairment. During a review of Resident 40's Lab Results Report dated 5/20/2025, the report indicated Resident 40 tested positive for COVID-19 on 5/20/2025. During an interview on 5/29/2025 at 1:52 p.m., the infection prevention nurse (IPN) stated the outbreak for COVID-19 began 5/14/2025 with 3 Residents testing positive. The IPN stated she reported to the Los Angeles County Department of Public Health (Local Agency) and the Centers of Disease Control and Prevention (CDC)'s National Healthcare Safety Network (NHSN, federal system) but not to the State Agency. The IPN stated she thought when she reported the outbreak to the Local Agency it reported it to the State Agency as well. During an interview on 5/30/2025 at 4:09 p.m., the Director of Nursing (DON) stated COVID-19 was a reportable disease. The DON stated she was not aware the State Agency was not informed of an outbreak if the outbreak is only reported to the Local Agency. The DON reviewed the All Facilities Letter (AFL, a letter from the State Agency's Licensing and Certification (L&C) Program to health facilities that are licensed or certified by L&C. The information contained in the AFL may include changes in requirements in healthcare, enforcement, new technologies, scope of practice, or general information that affects the health facility) 23-08 and now understood outbreaks had to be reported to the Local Agency as well as the State Agency. During a review of AFL 23-08 dated 1/18/2023, the AFL indicated COVID-19 outbreaks were considered an unusual infection occurrence facilities needed to report outbreaks and unusual infectious disease occurrences to the local public health officer and their respective District Office (DO, State Agency). 055758 Page 17 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0880 Level of Harm - Minimal harm or potential for actual harm A review of the facility's policy and procedure (P/P) titled Infection Outbreak Response and Investigation dated 12/19/2022, the P/P indicated an outbreak was to be reported to the local and/ or state health departments in accordance with the state's reportable diseases website. Residents Affected - Some 055758 Page 18 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0881 Implement a program that monitors antibiotic use. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to implement their policy and procedure (P/P) for Antibiotic Stewardship (the effort to measure and improve how antibiotics (a medication used to kill bacteria and to treat infections) are prescribed by clinicians and used by patients) for two of five sampled residents (Resident 43 and Resident 154) who were prescribed antibiotics without meeting criteria. Residents Affected - Some This deficient practice had the potential for Resident 43 and Resident 154 to develop antibiotic resistance (not effective to treat infection) from unnecessary or inappropriate antibiotic use. Findings: During a review of Resident 43's admission Record (Face Sheet), the admission Record indicated Resident 43 was admitted to the facility on [DATE] with diagnoses of type 2 diabetes (a long-term condition in which the body has trouble controlling blood sugar and using it for energy) with a foot ulcer (wound), osteomyelitis (bone infection), and complete amputation (removal) of the right foot at the ankle level. During a review of Resident 43's minimum data set (MDS, a resident assessment tool) dated 2/15/2025, the MDS indicated Resident 43 was cognitively (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) intact. During a review of Resident 43's Order Summary Report, the Order Summary Report indicated an order was placed 5/3/2025 for Piperacillin Sod-Tazobactam (a medication used to treat infections) Solution Reconstituted 3-0.375 grams (gm, a unit of measurement) intravenously (administered in the vein) three times a day. During a review Resident 43's Infection Screening Evaluation dated 5/3/2025, the Infection Screening indicated Resident 43's symptoms did not meet McGeer's (is for defining true infection) criteria. During a review of Resident 43's Antibiotic Time Out dated 5/5/2025, the Antibiotic Time Out form done for the use od Piperacillin did not indicate Resident 43's physician was notified that McGeer's criteria was not met for Resident 43. During a review of Resident 154's admission Record, the admission Record indicated Resident 154 was admitted to the facility 5/24/2025 with diagnoses of acute kidney failure (AKF) and urinary tract infection (UTI, infection of the system of organs that make urine). During a review of Resident 154's medical record, the history and physical and MDS had yet to be completed. During a review of Resident 154's Physician's Orders, an order was placed 5/24/2025 for Ciprofloxacin HCL (medication used to treat infection) Oral tablet 500 milligrams (mg, a unit of measurement), give by mouth once daily for UTI until 5/29/2025. During a review of Resident 154's Infection Screening Evaluation dated 5/24/2025, the Infection Screening indicated Resident 154 did not meet McGeer's criteria. 055758 Page 19 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0881 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview on 5/29/2025 at 1:52 p.m., the infection preventionist nurse (IPN) stated she Reviewed Resident 43's Infection Screening Evaluation dated 5/3/2205 and Resident 154's Infection Screening Evaluation dated 5/24/2025, the IPN stated neither Resident 43 nor Resident 154 met McGreer's criteria. The IPN stated Resident 43's Antibiotic Time out dated 5/5/2025 did not indicate the physician was notified Resident 43 did not meet McGreer's criteria. The IPN stated she was not aware Resident 154 had been taking antibiotics and the Antibiotic Time Out had not been done for the usage of Ciprofloxacin. The IPN stated the Antibiotic Time Out should be completed within 48 hours of the start of an antibiotic. The IPN stated it was important to review antibiotics as soon as possible and while the antibiotic was still active to ensure the resident needed the antibiotic and they were receiving the correct antibiotic. The IPN stated the physician needed to be informed that a resident did not meet criteria for antibiotic usage and if the physician still chose to continue the antibiotics, the conversation needed to be documented in the resident's chart. During an interview on 5/29/2025 at 4:09 p.m., the director of nursing (DON) stated the potential outcome of antibiotic stewardship not being done correctly or in a timely manner was the resident could become resistant to the antibiotic if the antibiotic was not necessary. During a review of the facility's policy and procedure (P/P) titled Antibiotic Stewardship Program dated 12/2022, the P/P indicated the purpose of the antibiotic stewardship program was to optimize the treatment of infections while reducing adverse events associated with antibiotic use. The P/P indicated the facility used McGeer criteria to define infections. The P/P indicated education regarding antibiotic stewardship program shall be provided to facility staff, prescribing practitioners, residents, and families. 055758 Page 20 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation , interview and record review the facility failed to ensure 33of 33 Residents room requirements of 80 square feet (sq.ft - a unit of area measurement ) per residents in multi-bed resident rooms were implemented. This deficient practice had the potential to result in inadequate provision of safe nursing care, and privacy for the residents. Findings : During a review the facility's Client Accommodation Analysis form provided by the facility on 5/27/2025 the facility had 33 rooms that measured less than 80 sq.ft per resident in multi-resident bedrooms and two rooms that measured less than 100 sq.ft for a single bedroom. The resident rooms were as follows: room [ROOM NUMBER] (2) beds 143.75 sq.ft. room [ROOM NUMBER] (2) beds 143.75 sq.ft. room [ROOM NUMBER] (2) beds 143.74 sq.ft room [ROOM NUMBER] (2) beds 143.75 sq.ft. room [ROOM NUMBER] (2) beds 143.75 sq.ft. room [ROOM NUMBER] (2) beds 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143,75 sq.ft room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75.sq.ft room [ROOM NUMBER] (2) 143.75 sq.ft room [ROOM NUMBER] (2) 143.75 sq.ft. 055758 Page 21 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0912 room [ROOM NUMBER] (2) 143.75.sq.ft. Level of Harm - Potential for minimal harm room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75.sq.ft. Residents Affected - Some room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75.sq.ft. room [ROOM NUMBER] (2) 143.75.sq.ft. room [ROOM NUMBER] (2) 143.75 sq.ft room [ROOM NUMBER] (2) 143.75 sq,Ft. room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] (2) 143.75 sq.ft room [ROOM NUMBER] (2) 143.75 sq.ft room [ROOM NUMBER] (2) 143.75.sq.ft room [ROOM NUMBER] (2) 143.75 sq.ft. room [ROOM NUMBER] ( 3) 220 sq.ft. During an interview on 5/30/2025 with the Maintenance Director (MS), the MS stated he was aware the room sizes were smalerl than required. The MS stated he has had no residents complaining they do not have enough room or that the rooms were too small. The MS stated the nurses do not complain the rooms are too small. During an interview on 5/2025 with the Administrator (ADM), the ADM stated she was aware the room sizes needed to be at least 160 square feet per resident in multiple resident's rooms . The ADM stated she had no complaints from residents or staff indicating the rooms were too small. The ADM stated she has an approved room waiver dated 2025. During a review of the facility's room waiver letter dated 2025, the room waiver letter indicated, it was approved on 2025. 055758 Page 22 of 23 055758 05/30/2025 Cottage Crest Post Acute 12350 Rosecrans Norwalk, CA 90650

F 0912 Level of Harm - Potential for minimal harm Residents Affected - Some During an observation and interview on 5/27/2025 through 5/30/2025 , the residents residing in their rooms had enough space to move freely inside the rooms . Each resident in the above rooms had beds and side tables with drawer. There was adequate room for the operation and use of walkers canes, wheelchairs and shower chairs. Residents room size did not affect the nursing care or privacy provided to the residents. During a review of the facility's policy and procedures(P&P) titled , Residents Rooms revised 12/2/2024 the P&P indicated residents bedrooms will measure at least 80 square feet per resident in multiple resident bedrooms and at least 100 square feet in single resident bedrooms. 055758 Page 23 of 23