Health inspection·December 18, 2024

F 0726 HTN. Hold if SBP <120 or HR < 50. Level of Harm - Minimal harm or potential for actual harm 4.) Norvasc (medication used to treat HTN) Oral tablet 10mg give 1 tablet by mouth in the morning for HTN. Hold for SBP <120 or HR <50. Residents Affected - Some During a review of Resident 2 ' s Medication Administration Report (MAR) dated from 12/1/2024-12/18/2024, the physician ' s parameters (specific, measurable instructions) were not followed when: 1.) Cozaar Oral tablet 100 mg give 1 tablet by mouth in the morning, hold if the SBP < 120 or HR <50 was given on 12/8/2024 with a BP of 117/66, 12/10/2024 with a BP of 100/64, and 12/11/2024 with a BP of 100/64. 2.) Isosorbide Mononitrate ER 24 hr. 30 mg, give 1 tablet in the morning for HTN. Hold if SBP <110 was given on 12/10/2024 with a BP of 100/64 and on 12/11/2024 with a BP of 100/64. 3.) Toprol XL oral tablet ER 24 hr. 25 mg give 1 tablet in the evening for HTN. Hold if SBP <120 or HR < 50 was given on 12/10/2024 with a BP of 100/64 and 12/11/2024 with a BP of 100/64. 4.) Norvasc Oral tablet 10mg give 1 tablet by mouth in the morning for HTN. Hold for SBP <120 or HR <50 was given on 12/8/2024 with a BP of 117/66, 12/10/2024 with a BP of 100/64, and 12/11/2024 with a BP of 100/64. b. During a review of Resident 1 ' s admission Record, the admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses of heart failure and hypertensive emergency (a medical emergency that involves extremely high blood pressure and signs of organ damage that could be life-threatening). During a review of Resident 1 ' s Medication Review Report, the report indicated orders were placed 11/21/2024 for: 1.) Entresto Oral Tablet 24-26mg give 1 tablet by mouth two times a day for heart failure hold if SBP <120 or HR <50. 2.) Lasix (treats swelling associated with heart failure, and lowers blood pressure) Oral Tablet 20 mg, give 1 tablet in the morning for edema (swelling) hold if SBP <110 or HR <60. 3.) Toprol XL oral tablet ER 24 hr. 25 mg, give 1 tablet by mouth at bedtime for heart rate hold if SBP <110 or HR <60. During a review of Resident 1 ' s care plan initiated 11/22/2024, the care plan indicated Resident 1 had heart failure and was at risk for ineffective tissue perfusion (oxygen not circulating throughout body) with a goal for Resident 1 to demonstrate adequate cardiac output (the amount of blood the heart pumps in 1 minute) and normal vital signs. Interventions included Resident 1 receiving medications as ordered including Entresto (medication for heart failure) tablets and Toprol XL tablets. During a review of Resident 1 ' s MDS dated [DATE], the MDS indicated Resident 1 had severe cognitive impairment (a decline in cognitive function that makes it difficult for a person to live independently). (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055952 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 055952 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Care Center West, Inc 4333 Torrance Blvd Torrance, CA 90503 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some During a review of Resident 2 ' s Medication Administration Report (MAR) dated from 12/1/2024-12/18/2024, the physician ' s parameters were not followed when: 1.) Entresto Oral Tablet 24-26mg give 1 tablet by mouth two times a day for heart failure hold if SBP <120 or HR <50 was given at 9 a.m. on 12/1/2024 with a BP of 112/68, 12/2/2024 with a BP of 104/66, 12/4/2024 with a BP of 115/70, 12/8/2024 with a BP of 112/78, and 12/10/2024 with a BP of 109/69. Entresto Oral tablet 24-26mg was given at 5 p.m. on 12/4/2024 with a BP of 112/68. 2.) Lasix (treats swelling associated with heart failure, and lowers blood pressure) Oral Tablet 20 mg, give 1 tablet in the morning for edema (swelling) hold if SBP <110 or HR <60 was given on 12/6/2024 with a BP of 106/66 and 12/10/2024 with a BP of 109/69. 3.) Toprol XL oral tablet ER 24 hr. 25 mg, give 1 tablet by mouth at bedtime for heart rate hold if SBP <110 or HR <60 was given on 12/2/2024 with a BP of 106/65. During an interview and concurrent record review of Resident 1 ' s MAR (dated 12/1/2024-12/10/2024) on 12/18/2024 at 11:54 a.m., the director of nursing (DON) stated Resident 1 had physician ' s parameters for multiple blood pressure medications (Entresto hold if SBP <120, Lasix hold if SBP <110, and Toprol XL hold if SBP <110). The DON stated the facility policy was to take the blood pressure prior to giving the blood pressure medication and ensure the BP is not below the physician ' s parameters. The DON stated a check mark on the MAR meant the medication was given and per the DON Resident 1 ' s medication was given on the dates listed above when the BP did not meet the parameters to give the medication and the blood pressure lowering medications should have been held. The DON stated it was important to follow the physician ' s parameters because it could cause harm to the resident and if it was a blood pressure lowering medication, it could cause the blood pressure too low. The DON stated the nurses were not following physician ' s orders for Resident 1 and Resident 2 and the parameters were clearly ordered. The DON stated not following physician ' s orders for vital sign parameters was a big medication error. The DON stated it was not just one LVN making the mistake and not following physician ' s orders, but multiple LVNs (LVN 1, LVN 2, and LVN 4). The DON stated the nurses identified were not competent for medication administration and the potential outcome of LVNs not being documented during medication administration was the possibility to cause harm to the resident and medication errors could occur. During a review of the facility ' s policy and procedure (P/P) titled Medication Administration dated 11/2017, the P/P indicated nurses were to obtain and record the vital signs, when applicable or per the physician ' s orders prior to giving medications. The nurses were to hold the medication for those vital signs outside of the physician ' s prescribed parameters. During a review of the P/P titled Medication Errors dated 2/2023, the P/P indicated the facility must ensure it was free of significant medication error events. During a review of the facility ' s job description for the charge nurse- RN/LVN, undated indicated the charge nurse was to administer and document medications in compliance with facility P/P. Cross Reference: F760 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055952 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 055952 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Care Center West, Inc 4333 Torrance Blvd Torrance, CA 90503 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 0760 Ensure that residents are free from significant medication errors. 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 ensure two out of five sampled residents (Resident 1 and Resident 2) was free from a significant medication error by failing to follow the physician ' s ordered parameters (specific instructions) when administering blood pressure lowering medications. Residents Affected - Some This deficient practice had the potential for Resident 1 and Resident 2 to become hypotensive (low blood pressure, a sudden drop in blood pressure can cause symptoms like dizziness or fainting and can indicate that vital organs aren't getting enough blood flow.). Findings: a. During a review of Resident 2 ' s admission Record, the admission Record indicated Resident 2 was admitted to the facility 9/10/2019 with diagnoses of hypertension (HTN, high blood pressure) and dementia (a general term for a group of neurological conditions that cause a decline in mental abilities that affects daily life). During a review of Resident 2 ' s care plan initiated 9/18/2024, the care plan indicated Resident 2 was high risk for elevated blood pressure and Resident 2 was to remain free of complications related to HTN. Interventions included checking the blood pressure (BP) prior to giving medications and giving BP meds as ordered by the physician. During a review of Resident 2 ' s minimum data set (MDS, a federally mandated assessment tool) dated 12/13/2024, the MDS indicated Resident 2 was rarely or never understood. During a review of Resident 2 ' s Order Summary Report, the Order Summary Report indicated the following orders were placed 2/1/2024: 1.) Cozaar (medication for high BP) Oral tablet 100 milligrams (mg, a unit of measurement) give 1 tablet by mouth in the morning, hold if the systolic blood pressure (SBP, the top number of blood pressure) less than (<) 120 or heart rate (HR) <50. 2.) Isosorbide Mononitrate (medication that can be used to treat HTN) extended release (ER, medication designed to last longer in body) 24 hour (hr.) 30 mg, give 1 tablet in the morning for HTN. Hold if SBP <110. 3.) Toprol XL (medication for high BP) oral tablet ER 24 hr. 25 mg give 1 tablet in the evening for HTN. Hold if SBP <120 or HR < 50. 4.) Norvasc (medication used to treat HTN) Oral tablet 10mg give 1 tablet by mouth in the morning for HTN. Hold for SBP <120 or HR <50. During a review of Resident 2 ' s Medication Administration Report (MAR) dated from 12/1/2024-12/18/2024, the physician ' s parameters (specific, measurable instructions) were not followed when: 1.) Cozaar Oral tablet 100 mg give 1 tablet by mouth in the morning, hold if the SBP < 120 or HR <50 was given on 12/8/2024 with a BP of 117/66, 12/10/2024 with a BP of 100/64, and 12/11/2024 with a BP of 100/64. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055952 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 055952 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Care Center West, Inc 4333 Torrance Blvd Torrance, CA 90503 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 0760 Level of Harm - Minimal harm or potential for actual harm 2.) Isosorbide Mononitrate ER 24 hr. 30 mg, give 1 tablet in the morning for HTN. Hold if SBP <110 was given on 12/10/2024 with a BP of 100/64 and on 12/11/2024 with a BP of 100/64. 3.) Toprol XL oral tablet ER 24 hr. 25 mg give 1 tablet in the evening for HTN. Hold if SBP <120 or HR < 50 was given on 12/10/2024 with a BP of 100/64 and 12/11/2024 with a BP of 100/64. Residents Affected - Some 4.) Norvasc Oral tablet 10mg give 1 tablet by mouth in the morning for HTN. Hold for SBP <120 or HR <50 was given on 12/8/2024 with a BP of 117/66, 12/10/2024 with a BP of 100/64, and 12/11/2024 with a BP of 100/64. b. During a review of Resident 1 ' s admission Record, the admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses of heart failure and hypertensive emergency (a medical emergency that involves extremely high blood pressure and signs of organ damage that could be life-threatening). During a review of Resident 1 ' s Medication Review Report, the report indicated orders were placed 11/21/2024 for: 1.) Entresto Oral Tablet 24-26mg give 1 tablet by mouth two times a day for heart failure hold if SBP <120 or HR <50. 2.) Lasix (treats swelling associated with heart failure, and lowers blood pressure) Oral Tablet 20 mg, give 1 tablet in the morning for edema (swelling) hold if SBP <110 or HR <60. 3.) Toprol XL oral tablet ER 24 hr. 25 mg, give 1 tablet by mouth at bedtime for heart rate hold if SBP <110 or HR <60. During a review of Resident 1 ' s care plan initiated 11/22/2024, the care plan indicated Resident 1 had heart failure and was at risk for ineffective tissue perfusion (oxygen not circulating throughout body) with a goal for Resident 1 to demonstrate adequate cardiac output (the amount of blood the heart pumps in 1 minute) and normal vital signs. Interventions included Resident 1 receiving medications as ordered including Entresto (medication for heart failure) tablets and Toprol XL tablets. During a review of Resident 1 ' s MDS dated [DATE], the MDS indicated Resident 1 had severe cognitive impairment (a decline in cognitive function that makes it difficult for a person to live independently). During a review of Resident 2 ' s Medication Administration Report (MAR) dated from 12/1/2024-12/18/2024, the physician ' s parameters were not followed when: 1.) Entresto Oral Tablet 24-26mg give 1 tablet by mouth two times a day for heart failure hold if SBP <120 or HR <50 was given at 9 a.m. on 12/1/2024 with a BP of 112/68, 12/2/2024 with a BP of 104/66, 12/4/2024 with a BP of 115/70, 12/8/2024 with a BP of 112/78, and 12/10/2024 with a BP of 109/69. Entresto Oral tablet 24-26mg was given at 5 p.m. on 12/4/2024 with a BP of 112/68. 2.) Lasix (treats swelling associated with heart failure, and lowers blood pressure) Oral Tablet 20 mg, give 1 tablet in the morning for edema (swelling) hold if SBP <110 or HR <60 was given on 12/6/2024 with a BP of 106/66 and 12/10/2024 with a BP of 109/69. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055952 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 055952 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Torrance Care Center West, Inc 4333 Torrance Blvd Torrance, CA 90503 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 3.) Toprol XL oral tablet ER 24 hr. 25 mg, give 1 tablet by mouth at bedtime for heart rate hold if SBP <110 or HR <60 was given on 12/2/2024 with a BP of 106/65. During an interview and concurrent record review of Resident 1 ' s MAR (dated 12/1/2024-12/10/2024) on 12/18/2024 at 11:54 a.m., the director of nursing (DON) stated Resident 1 had physician ' s parameters for multiple blood pressure medications (Entresto hold if SBP <120, Lasix hold if SBP <110, and Toprol XL hold if SBP <110). The DON stated the facility policy was to take the blood pressure prior to giving the blood pressure medication and ensure the BP is not below the physician ' s parameters. The DON stated a check mark on the MAR meant the medication was given and per the DON Resident 1 ' s medication was given on the dates listed above when the BP did not meet the parameters to give the medication and the blood pressure lowering medications should have been held. The DON stated it was important to follow the physician ' s parameters because it could cause harm to the resident and if it was a blood pressure lowering medication, it could cause the blood pressure too low. The DON stated the nurses were not following physician ' s orders for Resident 1 and Resident 2 and the parameters were clearly ordered. The DON stated not following physician ' s orders for vital sign parameters was a big medication error. During a review of the facility ' s policy and procedure (P/P) titled Medication Administration dated 11/2017, the P/P indicated nurses were to obtain and record the vital signs, when applicable or per the physician ' s orders prior to giving medications. The nurses were to hold the medication for those vital signs outside of the physician ' s prescribed parameters. During a review of the P/P titled Medication Errors dated 2/2023, the P/P indicated the facility must ensure it was free of significant medication error events. Cross Reference: F726 FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055952 If continuation sheet Page 6 of 6