Health inspection·January 14, 2026

F 0607 Develop and implement policies and procedures to prevent abuse, neglect, and theft. Level of Harm - Minimal harm or potential for actual harm Based on interview and record review, the facility failed to implement its policy and procedures (P&P), titled Abuse (willful infliction of injury, unreasonable confinement, intimidation, or punishment, resulting in physical harm, pain, or mental anguish), Neglect (failure of staff to provide necessary care), Exploitation (illegal or improper act of using a resident's funds, property, or assets for another person's profit or advantage, often involving coercion, manipulation, or fraud) and Misappropriation (deliberate misplacement, exploitation, or wrongful temporary/permanent use of a resident's belongings or money without their consent) Prevention Program by failing to conduct required pre-employment screening prior to hiring one of two sampled employees (Certified Nursing Assistant 1 [CNA 1]). This deficient practice had the potential to place the residents at risk for elder abuseDuring a review of CNA 1's personnel file including the Personnel Action Form (PAF) dated 12/26/2024, the PAF indicated prior employment at Skilled Nursing Facility 1 (SNF 1) in the position/title of CNA. During a concurrent interview and record review on 1/14/2026 at 2:55 p.m., with the Director of Staff Development (DSD), CNA 1's personnel file including the Pre-Employment Reference Check List (PERCL) was reviewed. The DSD stated that CNA 1's date of hire (DOH) was 12/26/2024. The DSD stated that CNA 1's PERCL indicated the first reference interview as only a person's name (former employee, Restorative Nursing Assistant 1 [RNA 1]) with no title documented and dated 12/20/2024. The second reference interview indicated SNF 1's company name and the DSD's name; however, no interview date, employment verification dates, or additional information related to prior employment reference checks were documented. During a concurrent interview and record review on 1/14/2026 at 4:57 p.m., with the Director of Nursing (DON), CNA 1's personnel file including the PAF and PERCL were reviewed. When the DON was asked about the relationship between pre-employment background checks and the resident abuse prevention program, the DON stated that the facility should complete pre-employment reference checks prior to hiring a new employee to ensure safety, confirm qualifications, and determine whether a potential employee has any history of resident abuse, as the facility provides care and services to elderly residents. When the DON was asked whether individuals in RNA or CNA positions could provide professional employment references for a potential new employee, the DON stated that RNA or CNA staff are not able to provide professional reference checks, including verification of employment history. The DON further stated that CNA 1's reference appeared to be a personal reference from RNA 1 and that the former DSD did not complete CNA 1's PERCL prior to hire, as the form lacked required information and documentation. During a concurrent interview and record review on 1/14/2026 at 5:08 p.m., with the Administrator (ADM) and the DON, CNA 1's personnel file including the PAF and PERCL were reviewed. The ADM stated that the purpose of conducting pre-employment checks is to identify any negative history that the facility should, at a minimum, attempt to contact a new applicant's former or current employers to obtain relevant information. The ADM stated it was difficult to determine whether pre-employment reference checks had been completed for CNA 1. During a review of the facility's P&P titled, Residents Affected - Few (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 055906 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 01/14/2026 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)