Health inspection·October 18, 2023

F 0580 9/10/23 234.5 lbs, Level of Harm - Minimal harm or potential for actual harm 9/16/23 223.5 lbs, 9/23/23 230 lbs and Residents Affected - Few 10/1/23 226.4 lbs. An interview and concurrent record review was conducted with LN 6 on 10/5/23, at 11:32 A.M. LN 6 stated Resident 5 had a weight loss of 10.5 lb on 9/1/23. LN 6 reviewed Resident 5's progress notes and stated the attending physician was not notified of the weight loss. LN 6 stated Resident 5 continued to have weight loss. Resident 12 was admitted to the facility on [DATE] with the diagnoses including Parkinson's Disease (a brain disorder causing uncontrolled movements, difficulty with balance and coordination). A review of the Registered Dietician's (RD) progress note dated 7/1/23 was conducted. The RD's note indicated Resident 12 was malnourished (poor nutrition). Additional progress note dated 8/18/23 indicated weight goals of 160 lbs to 175 lbs. An interview and concurrent record review was conducted with LN 6 on 10/5/23, at 11:41 A.M. LN 6 stated Resident 12 was on monthly weights. LN 6 reviewed Resident 12's weight record and stated Resident 12's weight on 8/1/23 was 165.5 lbs. LN 6 stated Resident 6's weight on 9/1/23 was 152.8 lb which was a 12.7 lbs weight loss in one month. Upon further review of Resident 6's progress notes, LN 6 stated Resident 6's physician was not notified of the weight loss. During an interview with the Director of Nursing (DON) on 10/18/23, at 12:45 P.M., the DON stated a resident's weight loss was considered a change of condition and it was important to notify the physician. The DON further stated the physician will the resident's medical record and provide orders to prevent further weight loss. A review of the facility's policy and procedure (P&P) titled, Guidelines for Notifying Physicians of Clinical Problems, dated September 2017 was conducted. The P&P indicated, .medical care problems are communicated to the medical staff in a timely, efficient, and effective manner .). FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055806 If continuation sheet Page 2 of 7 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 055806 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Las Palmas Healthcare Center 622 South Anza Street El Cajon, CA 92020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to ensure residents' nutritional status were monitored and meal intakes were accurately maintained for three residents with weight loss when: Residents Affected - Few 1. Resident's weights were not taken weekly. (Resident 10, Resident 5 and Resident 12) 2. Staff did not know how to take and record residents' meal percentage. These failures had the potential for residents to experience further weight decline and risk for functional decline, pressure sores and infection. Findings: 1. An interview was conducted with the Restorative Nurse Assistant (RNA- nurse assistants who help residents regain their ability to perform daily activities) on 10/5/23, at 11:05 A.M. The RNA stated residents who required weekly weights were taken on Saturdays and monthly weights were taken at the beginning of the month. The RNA stated a list of residents who required weekly weights were provided by a licensed nurse (LN). Resident 10 was admitted to the facility on [DATE] with the diagnoses including moderate protein-calorie malnutrition according to the facility's admission Record. A review of Resident 10's physician orders, titled, Order Summary Report, dated 10/6/23, the physician's orders indicated, weekly weights x 4, dated 9/20/23. During an interview and concurrent record review on 10/5/23, at 11:18 A.M. with Licensed Nurse (LN) 6, LN 6 stated weekly weights were completed upon admission, weekly for four weeks until stable. Upon review of Resident 10's weight record, LN 6 stated Resident 10 was not weighed weekly for the month of September 2023. LN 6 stated Resident 10 weighed 103.4 pounds (lbs- a unit of measurement) on 8/31/23, then 90.6 lbs on 10/1/23. LN 6 stated Resident 10 had a weight loss of 12.8 lbs since admission. Resident 5 was admitted to the facility on [DATE] with the diagnoses including dysphagia (difficulty swallowing) following cerebral infarction (disrupted blood flow to the brain) according to the facility's admission Record. A review of Resident 5's weight record was conducted. Resident 5's recorded weights in the facility's electronic medical record were as follows: 8/15/23 249.5 lbs 9/1/23 239 lbs 9/10/23 234.5 lbs 9/16/23 223.5 lbs (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055806 If continuation sheet Page 3 of 7 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 055806 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Las Palmas Healthcare Center 622 South Anza Street El Cajon, CA 92020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 9/23/23 230 lbs Level of Harm - Minimal harm or potential for actual harm and 10/1/23 226.4 lbs. Residents Affected - Few An interview and concurrent record review was conducted with LN 6 on 10/5/23, at 11:32 A.M. LN 6 stated Resident 5 was not weighed the week after 8/15/23 and the next weight was taken on 9/1/23 which showed a weight loss of 10.5 lbs. Resident 12 was admitted to the facility on [DATE] with the diagnoses including Parkinson's Disease (a brain disorder causing uncontrolled movements, difficulty with balance and coordination). A review of the Registered Dietician's (RD) progress note dated 9/25/23 was conducted. The RD's note indicated weekly weights was recommended. An interview and concurrent record review was conducted with LN 6 on 10/5/23, at 11:41 A.M. LN 6 stated Resident 12 was weighed monthly. LN 6 reviewed Resident 12's weight record and stated Resident 12's weight on 8/1/23 was 165.5 lbs. LN 6 stated Resident 6's weight on 9/1/23 was 152.8 lbs which was a 12.7 lbs weight loss in one month. An interview was conducted with the RD on 10/5/23, at 11:51 A.M. The RD stated residents' weights were taken on admission, weekly for four weeks, then monthly if stable. The RD further stated residents who were at risk or with unintended weight loss also required weekly weights. The RD further stated weekly weights upon admission to the facility was important because residents were in a new environment and needed time to adjust, then the resident's baseline weight can be assessed. During an interview with the Director of Nursing on 10/5/23, at 2:04 P.M., the DON stated residents were weighed initially upon admission weekly for four weeks. The DON stated the RD determined if residents will be added to their weight variance meetings. The DON further stated weekly weights were changed to monthly if residents were stable. A review of the facility's policy and procedure (P&P) titled, Weight Assessment and Intervention, dated March 2022 was conducted. The P&P indicated, .Resident weights are monitored for undesirable or unintended weight loss . 2. An interview was conducted with CNA 6 on 10/3/23, at 10:21 A.M. CNA 6 stated resident's meal percentage was determined based on what was served on the plate and the soup. CNA 6 stated soup was 10% or 15% of the meal. An interview was conducted with LN 4 on 10/3/23, at 10:36 A.M. regarding how meal percentages were determined. LN 4 stated percentage of resident's meal was determined by looking at the tray and what the resident ate. LN 4 stated she was not sure how else to calculate meal percentages. During an interview on 10/5/23, at 11:00 A.M. with CNA 7, CNA 7 stated resident's meal percentage depended on the portions of the main meal and three portions of the meal eaten would be 75%. An interview was conducted with the Director of Nursing on 10/18/23, at 12:45 P.M. The DON stated residents' meal percentages should be accurate to ensure accuracy of weight variances and follow up as needed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055806 If continuation sheet Page 4 of 7 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 055806 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Las Palmas Healthcare Center 622 South Anza Street El Cajon, CA 92020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0684 The facility did not provide a policy and procedure regarding residents' meal percentages. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055806 If continuation sheet Page 5 of 7 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 055806 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Las Palmas Healthcare Center 622 South Anza Street El Cajon, CA 92020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to implement infection control standards of practice when: Residents Affected - Some 1. A dedicated blood pressure cuff, stethoscope and thermometer were not available for eight residents who were on contact isolation precautions for a multi-drug resistant organism (MDRO-bacteria that developed resistance to one or more classes of antibiotics). 2. Face shields or eye protection were not available for staff to use upon entering a resident room with a diagnosis of Coronavirus (COVID-19 an infectious respiratory infection). These failures had the potential to expose other residents, staff, and visitors to infection. Findings: 1. An interview was conducted with the Infection Preventionist (IP) on 9/29/23, at 10:07 A.M. The IP stated the residents in rooms 123 (with three residents), 128 (with two residents) and room [ROOM NUMBER] (with three residents) were in contact isolation precautions. The IP stated the residents in room [ROOM NUMBER] had the diagnosis of candida auris (C. Auris- an MDRO, a multidrug resistant yeast that can cause severe infections, a county-reportable infectious disease). The IP further stated the residents in rooms [ROOM NUMBERS] had the diagnosis of carbapenem-resistant Acinetobacter baumannii (CRAB- a county-reportable infectious disease, an MDRO which makes infections very difficult to treat). An observation of the facility ' s [NAME] Wing 3 and [NAME] Wing 4 was conducted on 9/29/23 at 10:59 A.M. Rooms 123, 128 and 129 had a sign on the wall next to the door which indicated, Stop, and to check with the nurse before entering. Outside the rooms were plastic carts with three drawers. room [ROOM NUMBER] cart included disposable gloves, disposable yellow gowns and one white blood pressure cuff inside the drawers. A tub of hydrogen peroxide (chemical that kills certain bacteria) disinfectant wipes on top of the cart. room [ROOM NUMBER] ' s cart included gloves, gown, one white blood pressure cuff with yellow stethoscope in a sealed plastic bag. A tub of disinfectant wipes was on top of the cart. A stop sign was also posted on the wall next to the door. room [ROOM NUMBER] ' s cart included gloves, gown, one yellow disposable stethoscope and one blood pressure cuff. CNA 2 was observed entering room [ROOM NUMBER] with an N-95 mask, gown and gloves on 9/29/23 at 11:19 A.M. During an interview with CNA 2 after exiting the room, CNA 2 stated the three residents in room [ROOM NUMBER] had the diagnosis of CRAB or C. Auris. CNA stated the residents were on isolation because the bacteria was contagious to the skin, and gown with gloves were needed to protect the residents and staff. CNA 2 stated blood pressure cuffs should be in the cart and each resident should have a dedicated equipment. A joint observation of rooms [ROOM NUMBERS] was conducted with CNA 2. CNA 2 stated the carts did not have dedicated blood pressure cuffs and stethoscopes for each resident. During an interview with CNA 3 on 9/29/23, at 11:50 A.M., CNA 3 stated residents on isolation had their own vital sign machine which was kept at the nurse ' s station. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055806 If continuation sheet Page 6 of 7 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 055806 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/18/2023 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Villa Las Palmas Healthcare Center 622 South Anza Street El Cajon, CA 92020 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During an interview with LN 1 on 9/29/23, at 11:52 A.M., LN 1 stated there were no vital signs machine for resident on isolation. LN 1 stated rooms on isolation had carts outside the room with a blood pressure cuff in the drawer. LN 1 stated she was unsure if the BP cuff was per room or per resident. An interview and concurrent observation was conducted with LN 2, on 9/29/23, at 11:58 A.M. LN 2 stated rooms with a stop sign should have disposable blood pressure cuff and stethoscope in the isolation cart outside the room or inside the room on a rack by the door. LN 2 checked the isolation carts for rooms 123, 128 and 129 and did not find dedicated blood pressure cuffs, stethoscopes, or thermometers in the isolation cart. In addition, LN 2 also checked inside the residents ' rooms and did not find dedicated blood pressure cuffs, stethoscopes, or thermometers inside the residents ' rooms. LN 2 stated each resident should have a dedicated vital sign equipment because they had an infection which could spread to others. During an interview with the Director of Nursing (DON) on 10/5/23, at 1:56 P.M., the DON stated residents with the diagnosis of CRAB and C. Auris should have dedicated vital signs equipment. The DON stated it was important for residents to have their own vital signs equipment to prevent the spread of infection to other residents. A review of the facility ' s policy and procedure (P&P) titled, Multidrug-Resistant Organisms, dated August 2019 was conducted. The P&P indicated, .Dedicate non-critical medical items to use on individual residents known to be infected or colonized with an MDRO . 2. An observation and interview was conducted on 10/3/23, at 9:34 A.M. with the IP. [NAME] wing 2 was observed with a barrier leading to rooms 111, 112 and 114. The IP stated rooms 111, 112 and 114 had residents who were positive for COVID-19. During a concurrent observation and interview with CNA 5 on 10/3/23, at 9:40 A.M., CNA 5 stated he was assigned to the residents with COVID-19. CNA 5 stated he wore an N-95 mask (a tight-fitting mask that filters airborne particles), goggles, gown, and gloves upon entering a room with COVID-19. Isolation carts outside rooms 111, 112 and 114 did not have goggles or face shields. An interview was conducted with the DON on 10/5/23, at 2:37 P.M. The DON stated staff should use a face shield when caring for residents with COVID-19. The DON further stated face shields were worn as protection since COVID-19 can be transmitted from a resident coughing. During a review of the facility ' s undated P&P titled, Coronavirus Disease 2019 (COVID-19) Mitigation Plan for Skilled Nursing Facilities, the P&P indicated, .Use safety glasses (e.g. face shields, trauma glasses, goggles) that have extensions to cover the side of the eyes when caring for resident with COVID-19 . FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055806 If continuation sheet Page 7 of 7