Health inspection·December 12, 2025

F 0637 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete that indicated, length - 3.1 cm, width - 6.0 cm, depth - not applicable. During a concurrent interview and record review on 9/24/2025 at 12:40 p.m., with the Minimum Data Set Coordinator (MDCS), Resident 1's Weight Summary and the SWEs were reviewed. When the MDSC was asked when a SCSA MDS should be completed, the MDSC stated that the SCSA MDS should be completed if there are changes in two or more MDS areas and the resident's condition is not expected to return to baseline in 14 days. The MDSC further stated that a SCSA comprehensive assessment should have been done for Resident 1 when Resident 1 had the significant weight loss, developed a blister that is considered stage II (Partial-thickness loss of skin, presenting as a shallow open sore or wound) PU on 8/22/2025, and when the sacrococcyx area had worsened on 9/3/2025, instead of the Quarterly assessment dated [DATE]. The MDSC stated that when completing a SCSA MDS, each IDT member would reassess the resident and review and or revise the resident's plan of care. During an interview on 9/26/2025 at 10:45 a.m. with the Director of Nursing (DON), the DON stated that Resident 1's SCSA MDS should have been completed on 9/4/2025 instead of a quarterly assessment due to the unplanned severe body weight loss and the newly developed PU on the right feet. The DON stated that the IDT should have reassessed Resident 1 to determine if there was a need to revise the Resident 1's care plan During a review of the facility's policy and procedure (P&P) titled Comprehensive Assessments last reviewed on 1/30/2025, the P&P indicated, Comprehensive MDS assessments are conducted to assist in developing person-centered care plans. Significant Change in Status Assessment (SCSA) - The SCSA is a comprehensive assessment for a resident that must be completed when the IDT has determined that a resident meets the significant change guidelines for either major improvement or decline. It can be performed at any time after the completion of admission assessment, and its completion date depend on the date that the IDT's determination was made that the resident had a significant change. A significant change is a major decline or improvement in a resident's status that: a. will not normally resolve itself without intervention by staff or by implementing standard disease related clinical interventions. b. impacts more than one area of the resident's health status; and c. requires interdisciplinary review and/or revision of the care plan. Event ID: Facility ID: 055906 If continuation sheet Page 2 of 6 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 055906 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rinaldi Convalescent Hospital 16553 Rinaldi St Granada Hills, CA 91344 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 0692 Provide enough food/fluids to maintain a resident's health. 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: 1. Obtain weekly weights as ordered for one of three sampled residents (Resident 1) 2. Ensure that staff monitored and documented intake (food and fluid consumption) and output (urine and stool amounts) in accordance with professional standards of practice and per the facility's policy and procedure (P&P) for one of three sampled resident (Resident 1), who had a gastrostomy tube (G-tube - a tube surgically inserted through the abdomen directly into the stomach to provide a way to deliver nutrition and medication when a person cannot eat or drink enough by mouth) and an indwelling catheter (a tube inserted into the bladder to allow urine to drain freely). This deficient practice had the potential to result in unrecognized weight changes, nutritional decline, and dehydration (a state where the body loses more water and fluids than it takes in). During a review of Resident 1's admission Record, the admission Record indicated that the facility originally admitted the resident on 5/28/2025 and readmitted on [DATE] with diagnoses including traumatic subarachnoid hemorrhage (SAH - bleeding in the space between the brain and the tissues that cover the brain) with loss of consciousness (the state of being awake and aware of one's surroundings), type 2 diabetes mellitus (DM - a chronic condition where your body either doesn't produce enough insulin [natural hormone that turns food into energy and manages your blood sugar level] or doesn't use insulin properly, causing too much sugar to build in the blood, leading to energy problems and potential organ damage over time) and neuromuscular dysfunction of the bladder (a condition where damage to the nerves that control the bladder [organ that stores urine] prevents normal bladder control and function). During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool) dated 9/4/2025, the MDS indicated that Resident 1's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and senses) was severely impaired. The MDS indicated that Resident 1 was dependent on staff with activities of daily living (ADLsactivities such as bathing, dressing and toileting a person performs daily) except for rolling left and right in bed, which Resident 1 required maximal staff assistance. 1. During a review of Resident 1's Physician's Orders dated 5/28/2025, the Physician's Orders indicated to obtain weekly weight for four (4) weeks. During a review of Resident 1's Weight Summary from 5/28/2025 to 6/17/2025, the Weight Summary indicated that Resident 1's weights, obtained using a mechanical lift (a device used to safely move residents who can't bear their own weight or whose weight makes manual lifting risky for both the resident and facility staff), were as follows: a. For Week 1 (5/28/2025 to 6/1/2025) - On 5/30/2025, Resident 1 weighs 194 pounds (lbs. - unit of weight)b. For Week 2 (6/2/2025 to 6/8/2025) - On 6/3/2025, Resident 1 weighs 194 lbs.c. For Week 3 (6/9/2025 to 6/15/2025) - Resident 1 was not weighed, and no weight was documented. d. For Week 4 (6/16/2025 to 6/22/2025) - Resident 1 was transferred to General Acute Care Hospital 1 (GACH 1) on 6/17/2025 During a concurrent interview and record review on 9/25/2025 at 7:50 a.m., with Restorative Nursing Assistant 1 (RNA 1 - a specialized certified nurse assistant [CNA] who helps residents regain or maintain physical function and independence through specific exercises and activities), Resident 1's Weight Summary from 5/28/2025 to 6/17/2025 was reviewed. RNA 1 stated that she (RNA 1) was unable to find documented evidence that Resident 1's Weekly Weight for Week 3 (6/9/2025 to 6/15/2025) was obtained. During a concurrent interview and record review on 9/25/2025 at 1:35 p.m., with Registered Nurse 1 (RN 1), Resident 1's Physician's Orders dated 5/28/2025 and Resident 1's Weight Summary from 5/28/2025 to 6/17/2025 were reviewed. RN 1 stated that the weight for the week of 6/9/2025 to 6/15/2025 was missed. RN 1 stated that obtaining weekly weights was important because Resident 1 has behavioral episodes involving pulling out the G-tube. RN 1 further stated that weekly weights Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055906 If continuation sheet Page 3 of 6 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 055906 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rinaldi Convalescent Hospital 16553 Rinaldi St Granada Hills, CA 91344 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some should be monitored to assess baseline nutrition and hydration (the process of maintaining adequate water levels in the body) status and to determine whether weekly weights should continue, particularly if there is unplanned or undesired weight loss or gain. During a review of the facility's P&P titled Weight Assessment and Intervention last reviewed on 1/30/2025, the P&P indicated, Resident weights are monitored for undesirable or unintended weight loss or gain. Residents are weighed upon admission and at intervals established by the interdisciplinary team (IDT - a group of healthcare professionals and staff from different areas who work together to create the best possible care plan for a resident) . 2. During a review of Resident 1's Physician Order Summary Report, the Physician Order Summary Report indicated the following orders: - Admit to the facility under the service of Primary Care Physician 1 (PCP 1). Order Date: 5/28/2025. - Enteral (providing nutrition and medicine directly into the digestive system via a feeding tube rather than by mouth) Feeding Order: Provide Glucerna (a brand of specialized nutritional product specifically used for residents with DM or high blood sugar levels) 1.5 via G-tube for a total of 1500 cubic centimeters (cc - unit of measure) at rate of 75 cc for 20 hours or until dose met. Order date: 5/28/2025. Foley Catheter (brand name for a type of indwelling catheter, a thin flexible tube inserted into the urethra [the tube that carries urine from the bladder out of the body] to drain urine from the bladder) French (Fr- a unit of measurement for the catheter's external diameter) 16/10 (One Fr is equal to 1/3 of a millimeter [mlunit of measure], so a higher Fr number indicates a wide catheter) care every shift. Order Date: 5/30/2025. During a concurrent interview and record review on 9/25/2025 at 10:39 a.m., with Licensed Vocational Nurse 1 (LVN 1), Resident 1's medical chart was reviewed. There was no documented evidence found that staff had completed intake and output (I/O) monitoring from 5/28/2025 to 9/18/2025. LVN 1 stated that the admission nurse did not include I/O monitoring in the admission orders, which resulted in staff not monitoring or documenting I/O in the Medication Administration Record (MAR - a daily documentation record used by a licensed nurse to document medications and treatments given to a resident). LVN 1 further stated that per facility's protocol, I/O should be monitored for at least one month following admission for residents with G-tube and an indwelling catheter, after which the need for continued monitoring is evaluated but failed to do so for Resident 1. LVN 1 stated that a resident's nutritional status and hydration needs, including fluid retention or deficits, are assessed by monitoring intake and output for residents with G-tube. LVN 1 stated that there was no intake and out monitoring performed from the initial admission on [DATE] until the most recent hospitalization on 9/18/2025. During an interview on 9/25/2025 at 5:19 p.m., with the Assistant Director of Nursing (ADON), the ADON reviewed Resident 1's from 5/28/2025 to 9/18/2025. The ADON stated that the licensed nurses did not monitor or document Resident 1's intake and output in the MAR. When the ADON was asked why Resident 1 needed intake and output monitoring, the ADON stated that it is necessary to assess the resident's nutritional status, fluid balance and hydration status. During an interview on 9/26/2025 at 10:17 a.m., with the Director of Nursing (DON), the DON stated that admitting nurses should include monitoring intake and output for residents with G-tube feeding and/or indwelling catheter in the Physician's Orders upon admission and readmission to the facility. The DON further stated that Resident 1's intake and output should have been monitored beginning at admission and during the first four weeks following admission or readmission to assess the resident's nutritional and hydration status after hospitalization. The DON stated that if the Physician's Order for intake and output monitoring was missed by the admitting nurses, clinical staff reviewing the resident's clinical records for a new admission or re-admission should identify the omission. The DON further stated that monitoring intake and output is especially important for residents, like Resident 1, who have episodes of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055906 If continuation sheet Page 4 of 6 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 055906 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rinaldi Convalescent Hospital 16553 Rinaldi St Granada Hills, CA 91344 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 0692 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete pulling out or disconnecting the G-tube. During a review of the facility's P&P titled Intake and Output (I&O), Monitoring of last reviewed on 1/30/2025, the P&P indicated, Intake and output is monitored and accurately documented when it is ordered by the resident's physician or implemented by the licensed nurse or interdisciplinary team (IDT) to evaluation hydration, fluid restrictions, or assist in assessment and management of fluid needs. I&O records may be instituted upon new symptoms of inadequate fluid volume balance, as a nursing measure, physician's order or per IDC recommendation. During a review of the facility's P&P titled Intake and Output, Monitoring of last reviewed on 1/30/2025, the P&P indicated, Residents admitted with a urinary catheter, or existing resident with a newly inserted urinary catheter, will be placed on I&O for 30 days with an evaluation included in the weekly nursing progress notes. I&O monitoring will be implemented by the facility when needed to evaluate resident's I&O status and will be discontinued when resident's status is consistent with their overall treatment plan, or as discontinued per physician's order. Event ID: Facility ID: 055906 If continuation sheet Page 5 of 6 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 055906 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Rinaldi Convalescent Hospital 16553 Rinaldi St Granada Hills, CA 91344 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 0770 Provide timely, quality laboratory services/tests to meet the needs of residents. 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 follow the physician's orders dated 8/26/2025 to obtain laboratory services (any examination of materials derived from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of human beings) for one of five sampled residents (Resident 1). This deficient practice had the potential to negatively affect the provision of necessary care and services to meet Resident 1's needs.Findings:During a review of Resident 1's admission Record, the admission Record indicated that the facility admitted the resident originally on 5/28/2025 and readmitted on [DATE] with diagnoses including traumatic subarachnoid hemorrhage (SAH - bleeding in the space between the brain and the tissues that cover the brain) with loss of consciousness, gastrostomy tube (G-tube, a feeding tube that is surgically placed through a small opening in the abdomen through the stomach to allow feedings to be administered directly to the stomach), and neuromuscular (of or relating to nerves and muscles) dysfunction (abnormal) of bladder. During a review of Resident 1's Minimum Data Set (MDS - a comprehensive assessment and screening tool) dated 9/4/2025, the MDS indicated that Resident 1's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and senses) was severely impaired. The MDS indicated that Resident 1 was dependent on staff with activities of daily living (ADLsactivities such as bathing, dressing and toileting a person performs daily) except for rolling left and right in bed which the Resident 1 required maximal assistance from staff. During a review of Resident 1's physician order summary report, the order summary report indicated an order dated 8/26/2025 that the following laboratory (lab) tests were to be done: Complete Blood Count (CBC - an all-purpose blood test; combining diagnostic evaluations of red blood cell count, white cell count, erythrocyte indices, hematocrit, and a differential blood count), Comprehensive Metabolic Panel (CMP - a blood test that measures several substances in the body to assess overall metabolic health and organ function), and Magnesium (a type of electrolytes, help control the amount of fluid and the balance of acids). During a concurrent interview and record review on 9/25/2025 at 12:16 p.m. with LVN 3, Resident 1's physician's orders and Lab & Radiology binder were reviewed. LVN 3 stated that the physician's order dated 8/26/2025 to perform CBC, CMP, and magnesium lab tests were not done on 8/26/2025. LVN 3 stated that the order requisition slip (a form used by healthcare staff to request specific tests, procedures, or services) for the lab tests scheduled on 8/26/2025 was folded, which meant that the phlebotomist (a trained healthcare professional who draws blood from people for medical tests) did not take Resident 1's blood samples on 8/26/2025. During a concurrent interview and record review on 9/25/2025 at 2:05 p.m. with Registered Nurse 1 (RN 1), Resident 1's physician's orders were reviewed. RN 1 stated that the physician's order dated 8/26/2025 to perform CBC, CMP, and magnesium lab tests were not done and that the physician was not informed of the missed lab tests. RN 1 further stated that it was important to follow the physician's order to obtain laboratory services because the lab test results would provide information about the Resident 1's nutritional and hydration status. During a review of the facility's policy and procedure (P&P) titled Lab and Diagnostic Test Results - Clinical Protocol last reviewed on 1/30/2025, the P&P indicated, The physician will identify, and order diagnostic and lab testing based on the resident's diagnostic and monitoring needs. The staff will process test requisitions and arrange it for tests. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055906 If continuation sheet Page 6 of 6