Health inspection·July 11, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to protect two out of four sampled residents (Resident 1 and Resident 2) from verbal abuse (mental abuse that involves the use of oral or written language directed to a victim. Verbal abuse can include the act of harassing [unwanted offensive or humiliating comments or behavior], insulting [a rude expression intended to offend or hurt), scolding (point out and criticize some fault or error, often angrily], criticize sharply, or excessive yelling towards an individual) and neglect (in the context of caregiving, neglect is a form of abuse where the perpetrator, who is responsible for caring for someone who is unable to care for themselves, fails to do so) by certified nursing assistant (CNA) 1.As a result of this deficient practice Resident 1 felt upset and Resident 2 felt bad, like a burden, and upset. Both Resident 1 and Resident 2 requested that CNA 1 was not assigned (designated) as their CNA anymore. 1.During a review of Resident 1's admission Record (face sheet), the admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses including hemiplegia (unable to move one side of the body) affecting the left side, contractures (a shortening of muscles, tendons, skin, and nearby soft tissues that causes the joints to shorten and become very stiff, preventing normal movement) of multiple sites, and major depressive disorder (persistent feelings of sadness and loss of interest).During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool) dated 6/18/2025, the MDS indicated Resident 1 was cognitively (the processes of thinking and reasoning) intact. The MDS indicated Resident 1 was dependent (helper does all the effort) on staff for toileting, dressing, showering, rolling left to right, and personal hygiene.2. During a review of Resident 3's admission Record, the admission Record indicated Resident 3 was admitted to the facility on [DATE] with diagnoses including dysarthria (weakness in the muscles used for speech, which often causes slowed or slurred speech), encephalopathy (damage or disease that affects the brain), and lack of coordination.During a review of Resident 3's MDS dated [DATE], the MDS indicated Resident 3 had moderate cognitive impairment.3. During a review of Resident 2's admission Record, the admission Record indicated Resident 2 was admitted to the facility on [DATE] with diagnoses including cervical spine (uppermost segment of the spine that's located in the neck) injury, lack of coordination, and neuromuscular dysfunction of bladder (refers to what happens when an injury or disease interrupts the electrical signals between your nervous system and bladder function).During a review of Resident 2's MDS dated [DATE], the MDS indicated Resident 2 was cognitively intact. The MDS indicated Resident 2 used a wheelchair for mobility. The MDS indicated Resident 2 was dependent on staff for showering and lower body dressing. The MDS indicated Resident 2 required substantial/ maximum assistance (helper does more than half the effort) for toileting, oral hygiene, upper body dressing, and to move from lying to sitting. The MDS indicated Resident 2 required partial/ moderate assistance (helper does less than half the effort) to transfer from the bed to the chair.During a review of CNA 1's Employee Corrective Action notice dated 6/5/2025, the Employee Corrective Action Notice indicated CNA 1 performed unsatisfactory customer service and failed to follow instructions, by CNA 1 being observed standing right across two resident rooms (unknown) that had call lights on, and CNA 1 failed to answer the call buttons for either room. The Employee Corrective Action note indicated CNA 1 refused to sign the corrective action.During a review of the facility's Nursing Assignment 7 a.m.- 3 p.m., Shift dated 7/3/2025, CNA 1 was assigned to Resident 2.During a review of the facility's Nursing Assignment 7 a.m.- 3 p.m., shift dated 7/8/2025, CNA 1 was assigned to Resident 1.During a review of Resident 1's Complaint/ Grievance Report filed on 7/8/2025, the Complaint/ Grievance Report indicated Resident 1 complained CNA 1 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055995 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 055995 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE North Long Beach Post Acute 260 E Market St Long Beach, CA 90805 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some had poor customer service and he did not want CNA 1 assigned to him anymore.During a review of Resident 2's Complaint/ Grievance Report filed 7/8/2025, the Complaint/ Grievance Report indicated Resident 2 complained CNA 1 had poor customer service and Resident 2 stated he had to wait awhile to get changed.During an interview on 7/10/2025 at 2:01 p.m., CNA 2 stated she felt as though CNA 1 was just coming to work to collect a paycheck and it did not seem as though she wanted to be at work. CNA 2 stated a few days prior (7/8/2025), Resident 1 complained about CNA 1's attitude.During an interview on 7/10/2025 at 3:23 p.m., Resident 1 stated CNA 1 was mean, always seemed angry, and made it seem as though she did not want to be at work. Resident 1 stated he reported CNA 1 to the Director of Staff Development (DSD) because on 7/8/2025 he needed help getting changed because his adult incontinence briefs (disposable garments designed for individuals experiencing lack of voluntary control of urinary or bowel) were wet and CNA 1 did not respond when he pressed his call button (alerts care givers that the resident required assistance). Resident 1 stated he called the nurses station with his cell phone because CNA 1 was not answering his call light, and the staff at the nurses station paged CNA 1 to go to his room. Resident 1 stated CNA 1 then came into his room and in a loud voice told him he was rude for calling the nurses station asking for her and then CNA 1 stated in a loud voice, why did you press the call button, what do you want. Resident 1 stated the interaction with CNA 1 made him upset because he needed help from CNA 1, she was angry he pressed the call button. Resident 1 stated he felt CNA 1 did not want to do her job and performed the care quickly. Resident 1 stated every time CNA 1 responded to the call button for himself or his roommate (Resident 3), CNA 1 was loud, and Resident 1 did not like how CNA 1 spoke to himself or Resident 3. Resident 1 stated his roommate had trouble communicating and every time CNA 1 answered Resident 3's call light she seemed angry towards Resident 3 so that was the last straw for him, so he reported CNA 1 to the DSD.During an interview on 7/10/2025 at 4:45 p.m., CNA 2 stated on 7/8/2025 Resident 1 complained about CNA 1's bad attitude. CNA 2 stated on 7/3/2025, Resident 2 complained about CNA 1. CNA 2 stated, Resident 2 complained he was in soiled adult briefs and CNA 1 made him wait to be changed for an extended amount of time. CNA 1 stated Resident 2 complained, he pressed the call button on 7/3/2025, CNA 1 answered the call button, turned it off and said, she was busy and would be back but did not come back for an extended amount of time.During an interview on 7/11/2025 at 9:35 a.m., Resident 2 stated on 7/3/2025, CNA 1 was assigned to him. Resident 2 stated his daily routine was to get changed and up in his wheelchair at 9 a.m. so he could participate in physical therapy (the treatment of disease, or injury, by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery) Resident 2 stated on 7/3/2025 he pressed the call button at 9 a.m., because he was wet and wanted to be changed to get up in the wheelchair. Resident 2 stated CNA 1 came into his room, turned off the call button and stated she was busy and would be back. Resident 2 stated CNA 1 did not come back until 11 a.m. to change him (two hours later) and when she came back CNA 1 looked angry and performed the care quickly. Resident 2 stated he was upset because the last time he was changed that morning was at 6 a.m., he was wet when he pressed the call button at 9 a.m. and he was not changed until 11 a.m. Resident 2 stated having to wait for CNA 1 for two hours in wet briefs, and missing physical therapy made him feel bad, and he did not press the call button again after 9 a.m. Resident 2 stated he felt like a burden that he was not able to perform the care himself and had to depend on other people to take care of his needs. Resident 2 stated that incident with CNA 1 threw off his whole day. Resident 2 stated he asked the facility not to assign CNA 1 to him anymore because she seems angry, upset about something, and does not want to be at work.During an interview on 7/11/2025 at 9:51 a.m., CNA 3 stated she works the 7 a.m. to 3 p.m. shift with CNA 1 and sometimes they buddy up to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055995 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 055995 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE North Long Beach Post Acute 260 E Market St Long Beach, CA 90805 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 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some perform care. CNA 3 stated she felt as though CNA 1's tone (how the character of your business comes through in your words) was off when speaking to residents and CNA 1 was very direct. CNA 3 stated, on 7/3/2025 around 2 p.m., Resident 2 pressed the call button and asked CNA 3 to inform CNA 1 he (Resident 2) needed to be changed. CNA 3 stated she witnessed CNA 1 respond to Resident 1 and said, I will be right there! CNA 3 stated the tone of CNA 2's tone of voice towards Resident 2, made her (CNA 3) feel bad. CNA 3 stated when CNA 1 was ready to change Resident 2, CNA 1 told Resident 2, okay I am ready to change you now! but Resident 2 had shut down and refused CNA 1's care. CNA 3 stated Resident 1 even started faking like he was sleeping so he did not have to talk to CNA 1 anymore and she felt bad for Resident 2 because this was out of character for him. CNA 3 stated she waited in the room with Resident 2 after CNA 1 left and asked him if he was okay and he responded he was upset and did not want to be changed anymore.During an interview on 7/11/2025 at 10:32 a.m., the Social Services Director (SSD) stated the facility received two grievances about CNA 1 (from Resident 1 and Resident 2) on 7/8/2025 and then they received a separate complaint from their compliance hotline on 7/9/2025 from an anonymous caller that identified CNA 1 as mistreating their family member. (CNA 1 was suspended on 7/9/2025 pending investigation).During an interview on 7/11/2025 at 10:53 a.m., the Director of Nursing (DON) stated; insulting or mocking a resident could be considered verbal abuse, and not addressing the resident's needs would be considered neglect. The DON stated that any Resident having to wait for two hours with wet/soiled incontinence briefs was too long and CNA 1 should have asked for help with her workload if she needed it so Resident 2 did not have to wait so long. The DON stated the potential outcome of a resident waiting for two hours for care included a urinary tract infections (UTI an infection of the system and organs that produce and excrete urine), skin issues such as maceration (skin becomes soft and fragile due to prolonged soaking), the risk of falls (due to resident try to get up unassisted to get out of wet/soiled briefs), and psychosocial harm because residents could feel unimportant. The DON stated the facility was the resident's home and they should be treated with dignity and respect. The DON stated talking to residents in a loud manner had the potential to affect residents' dignity negatively and they should not be talked to in that way. The DON stated the residents in the facility were dependent on staff care, so she felt bad if residents were being treated this way (left for extended periods and talked to in a loud and direct manner). The DON stated they did not tolerate abuse or neglect by facility employees and had they been aware, it was not just a bad customer service issue they would have reported the grievances right away to the state department, ombudsman (official resident advocate), and local law enforcement agency as required by regulations.During an interview on 7/11/2025 at 12:19 p.m., the DSD denied knowing the extent of the allegations from Resident 1 and Resident 2 and stated she was only aware of a bad customer service issue, CNA 1 not being friendly, and Resident 1 claiming CNA 1 was rude. The DSD stated there was no reason staff should talk to patients out of line and staff needed to ensure they were providing all necessary care for the residents. The DSD stated she expected her staff to be professional and treat their residents with dignity and respect. The DSD stated there was potential for residents to feel discouraged by staff if they were not talked to appropriately.During a review of the facility's policy and procedure (P/P) titled Abuse Prohibition Policy and Procedure dated 2/23/2021, the P/P indicated the facility prohibited abuse, mistreatment, and neglect. Instances of abuse of all patients, irrespective of any mental or physical condition, cause harm, pain, or mental anguish and included verbal abuse. Neglect was defined as the failure of the facility and its employees to provide goods and services to a patent that are necessary to avoid physical harm, pain, mental anguish or emotional distress. The P/P indicated the facility was to identify, correct, and intervene in (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055995 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 055995 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE North Long Beach Post Acute 260 E Market St Long Beach, CA 90805 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 0600 Level of Harm - Minimal harm or potential for actual harm situations in which abuse or neglect was more likely to occur.During a review of the facility's P/P titled Answering the Call Light dated 10/24/2025, the P/P indicated facility staff were to answer the call system request for assistance, identify themselves, and politely respond to the resident. The P/P indicated facility staff were to inform the residents how long it would take staff to respond to the request and if the staff was unable to fulfill the request, ask the nurse supervisor for assistance. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055995 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 055995 B. Wing A. Building (X3) DATE SURVEY COMPLETED 07/11/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE North Long Beach Post Acute 260 E Market St Long Beach, CA 90805 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 monitor the fluid intake (the amount of liquids consumed by an individual) for one out of two sampled residents (Resident 6), who was at risk of dehydration (a dangerous loss of body fluid caused by illness, sweating, or inadequate intake).As a result of this deficient practice Resident 6 was placed at risk for developing dehydration. Resident 6 was readmitted to a general acute care hospital (GACH) with a diagnosis of severe dehydration on 6/29/2025.During a review of Resident 6's admission Record, the admission Record indicated Resident 6 was originally admitted to the facility on [DATE] and was readmitted on [DATE] with diagnoses of hypernatremia (high concentration of sodium [salt] in blood which most often occurs from not drinking enough fluids), acute kidney failure (AKI, when the kidneys suddenly can't filter waste products from the blood), and Alzheimer's disease (a progressive disease that destroys memory and other important mental functions).During a review of Resident 6's minimum data set (MDS, a resident assessment tool) dated 6/9/2025, the MDS indicated Resident 6 had severe cognitive (relating to or involving the processes of thinking and reasoning) impairment and required partial/ moderate assistance (helper does less than half the effort). During a review of Resident 6's untitled Care Plan dated 6/23/2025, the focus of the care plan was, Resident 6 was at risk for dehydration as evidenced by AKI, recent hospitalization (5/26/2025), and hypernatremia. The care plan goal was Resident 6 would not exhibit signs or symptoms of dehydration. The Care Plan interventions included monitoring for signs and symptoms (S/S) of dehydration (S/S not specified) and offering/ encouraging/ assisting Resident 6 with fluid intake.During a review of Resident 6's Documentation Survey Report- Tasks for the months of 6/2025 and 7/2025, Resident 6 did not have any entries for Fluid Intake every shift.The Documentation Survey Report indicated facility staff were not monitoring and documenting Resident 6's fluid intake during the months of 6/2025 and 7/2025.During a review of Resident 6's GACH record titled History and Physical (H&P) dated 6/29/2025, the H&P indicated Resident 6 was readmitted to the GACH on 6/29/2025. The H&P indicated Resident 6 appeared very dehydrated and had severe hypernatremia likely due to dehydration.During a concurrent interview and record review on 7/10/2025 at 2:26 p.m., with certified nursing assistant (CNA) 3, Resident 6's Task documentation was reviewed. CNA 3 stated Resident 6 was not able to eat and drink on his own, he was a total feeder (staff must feed him and provide fluids). CNA 3 stated staff always offer Resident 6 water with his meals, but he always pushes it away. CNA 3 stated the CNAs chart how much a resident drinks each shift under TasksFluid Intake. CNA 3 reviewed Resident 6's Task and stated Resident 6 did not have a Task to monitor Fluid Intake. CNA 3 stated there was nowhere else the CNAs would chart how much a resident was drinking each shift.During a concurrent interview and concurrent interview on 7/11/2025 at 10:53 a.m., with the director of nursing (DON), Resident 6's Task- Fluid Intake were reviewed. The DON stated Resident 6 was elderly and had advanced Alzheimer's disease placing him at risk of dehydration. The DON stated it was important to track Residents' (general) fluid intake for residents at risk of dehydration. The DON stated the facility tracked residents' fluid intake by inputting the information under Tasks-Fluid Intake. The DON stated she reviewed Resident 6's Tasks- Fluid Intake but there was no active task, and she did not know why because Resident 6 was at risk for dehydration. The DON stated it was important to monitor fluid intake because they want to maintain hydration and nutrition.During a review of the facility's policy and procedure (P/P) titled Resident Hydration and Prevention of Dehydration dated 3/4/2025, the P/P indicated if a resident had potential inadequate intake or signs and symptoms of dehydration, intake and output monitoring was to be initiated and incorporated into the plan of care. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 055995 If continuation sheet Page 6 of 6