Health inspection·January 18, 2024

F 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few touching/steadying and assistance as resident completes activity) with toileting and set up or clean-up assistance (helper sets up or clean up resident; resident completes activity. Helper assists only prior to or following the activity) with eating. During a concurrent observation and interview on 1/18/2024 at 10:00 AM with Licensed Vocational Nurse (LVN) 1, observed LVN 1 after interacting with the residents in the hallway, LVN1 entered Resident 3s room with Resident 3 ' s medication in a cup without perform hand hygiene. LVN1 stated, He should have performed hand hygiene before entering the room and giving Resident 3 her medication, it just slipped his mind. LVN 1 stated, it is important to perform hand hygiene before caring for residents to prevent the spread of bacteria and viruses such as covid 19, especially we had an outbreak in the facility. During a review of Resident 2s admission Record dated 1/18/2024, indicated Resident 2 was admitted to the facility on [DATE], with diagnoses that included Chronic Pulmonary Edema , acute respiratory failure (a condition in which the lungs have a hard time loading the blood with oxygen or removing carbon dioxide) and pneumonia (an infection that inflames the air sacs in one or both lungs). A review of Resident 2s History and Physical Examination, dated 12/18/2023, indicated Resident 2 does not have the capacity to understand and make decisions. A review of Minimum Data Set (MDS, a standardized assessment and care screening tool), date 12/18/2023, indicated Resident 2s cognitive skills was severely impaired. The MDS indicated Resident 2 was dependent (helper does all the effort) with rolling left to right, bed to chair, toilet transfer and toileting, required substantial/maximal assist (helper does more than half the effort) with dressing and bathing, required partial/moderate assistance with oral hygiene and supervision or touching assistance with eating. During a concurrent observation and interview on 1/18/2024 at 10:28 AM with certified nurse assistant (CNA) 2, observed CNA 2 brought a towel to Resident 2s room and provided personal care to Resident 2 without performing hand hygiene. CNA 2 stated, she is aware she should have performed hand hygiene before entering the room and before providing personal care to Resident 2, especially during a Covid 19 outbreak in the facility. CNA 2 stated, not performing hand hygiene can cause the spread of bacteria and viruses, she just forgot. During an interview on 1/18/2024 at 1:30 PM with Director of Nurses (DON), stated her expectation was for the staff to perform hand hygiene prior to entering residents ' room and rendering care for their residents. DON stated, hand hygiene could prevent the spread of bacteria and viruses, and the staff should follow the covid outbreak policy and procedure. A review of the facility policy and procedure (P&P) titled, Hand Hygiene, revised 10/2022, the P&P indicated; a) all personnel shall follow the handwashing/hand hygiene procedures to help prevent the spread of infections to other personnel, residents, and visitors, c): Employees must use alcohol-based hand sanitizer before and after direct contact with residents., Before preparing or handing medications. A review of the facility policy and procedure (P&P) titled, Infection Prevention Quality Control Plan, revised 10/2022, the P&P indicated guidelines for general infection control while caring for residents include; 1)Standard precaution (infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin, and mucous (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055845 If continuation sheet Page 2 of 3 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 055845 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Leisure Glen Post Acute Care Center 330 Mission Road Glendale, CA 91205 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 membranes) will be used in the care of all residents in all situations regardless of suspected or confirmed the presence of infectious diseases, 3) Employees must wash their hands for 20 (twenty) seconds using antimicrobial or non-antimicrobial soap and water before and after direct contact with residents., 4) In most situations hand hygiene should be performed a. before and after direct contact with residents; d. before preparing or handling medications. Residents Affected - Few A review of the facility policy and procedure (P&P) titled, Covid-19, Prevention and Control, revised 9/29/2023, indicated prevention guideline included: Standard precautions- presumes that all moist body fluids from all residents/patients are colonized or infected with one or more transmissible infectious agents. In addition to hand hygiene, standard precaution requires gowns gloves, mask, and goggles when health care personnel (HCP) anticipate that their hands , clothes, mucous membranes of eyes, nose, or mouth or skin on the face will be exposed to blood or body fluids. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055845 If continuation sheet Page 3 of 3