Health inspection·August 28, 2025

F 0559 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 8/28/2025 at 9:48 AM with Resident 1, Resident 1 stated on 8/15/2025, while he was in his room sitting down coloring and doing crossword puzzles, his spouse (Resident 2) who also shares the same room, got mad at him due to frustration and started screaming for not paying attention to her. Resident 1 stated his wife (Resident 2) had been together for 80 years and are normally always happy and like all couples, have their arguments. Resident 1 stated he spoke briefly to Licensed Vocational Nurse 1 (LVN 1) but does not believe that he asked her to remove Resident 2 from their room. Resident 1 also stated that when they removed Resident 2 from their room, he only thought they were separating them for a short time like a time-out. During the same interview on 8/28/2025 at 9:48 AM with Resident 1, Resident 1 stated that he had been separated from Resident 2 for about 2 or three (3) weeks now. Resident 1 stated the facility staff never explained to him that he would be separated from Resident 2 for this long and only thought the separation would be brief. Resident 1 stated that if he had known they were going to move Resident 2 out of their room, he would have begged them to leave Resident 2 in their room. Resident 1 also stated that he has told multiple staff members, including LVN 1, that he would like Resident 2 to come back to their room. Resident 1 further stated he felt bad that Resident 2 was in another room and felt lonely and abandoned and just wanted her to be back in the same room with him. During an interview on 8/28/2025 at 10:01 AM with LVN 1, LVN 1 stated on 8/15/2025 she was sitting at the nurses' station when Resident 1 came up to her to ask to remove Resident 2 from their room. LVN 1 stated Resident 1 told her Resident 2 was screaming and throwing paper at him. LVN 1 stated she felt Resident 1 and Resident 2 were just having an argument between spouses and did not feel like it was verbal abuse (the harmful use of words to control, intimidate, threaten, or hurt someone, causing emotional distress and undermining their self-worth and can include insults, name-calling, excessive yelling, blaming and humiliation). LVN 1 also stated that Resident 2 was very upset when she was told she had to be separated from Resident 1. LVN 1 further stated that Resident 1 has asked her multiple times as well as witnessing Resident 1 ask Restorative Nursing Assistant 1 (RNA 1), the Director of Staff Development (DSD) and the Psychiatrist (a medical doctor who specializes in the diagnosis, treatment, and prevention of mental health disorders) to bring Resident 2 back to their room. During an interview on 8/28/2025 at 10:15 AM with Resident 2, Resident 2 stated on 8/15/202, she did not remember what she and Resident 1 were disagreeing on but stated it was just a disagreement. Resident 2 stated that both she and Resident 1 had been together for 80 years and married for 40 years. Resident 2 stated this is the first time they had been separated, and she misses Resident 1 and feels sad. Resident 2 further stated that she wishes to be in the same room as Resident 1 because she loves him and she takes care of him, and he does the same. During a concurrent observation and interview on 8/28/2025 at 10:20 AM with Resident 2 in the dining room, Resident 2 was observed crying. Resident 2 stated she did not realize it had already been 2 to 3 weeks since she has been separated from Resident 1. Resident 2 further stated that she only had a disagreement with Resident 1 and does not understand why or think that they should have been separated over it. During an interview on 8/28/2025 at 10:26 AM with DSD, DSD stated that Residents 1 and 2 do argue but have never heard them screaming. DSD also stated Resident 2 is hard of hearing and tends to speak loudly. DSD stated that Resident 1 has asked her about 3 times if they could bring Resident 2 back to his room so they could be back together and stated that Resident 2 has also expressed the same, asking to be back with her spouse. During an interview on 8/28/2025 at 10:53 AM with Resident 1, Resident 1 stated the facility staff did not ask him if he wanted Resident 2 to be moved to another room and when they did move Resident 2's things out of their shared room, they did not let him know what room she was moving to and reiterated that it made him feel sad and abandoned. During an interview on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056063 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 056063 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/28/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Infinity Care of East Los Angeles 101 S Fickett Street Los Angeles, CA 90033 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 0559 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete 8/28/2025 at 11:47 AM with SSD, SSD stated Residents 1 and 2 constantly argue and they were told on 8/13/2025 that they needed to stop or they would be separated. SSD stated both Residents 1 and 2 had another argument on 8/15/2025 and because Resident 1 had asked LVN 1 to remove Resident 2 from their room, it was reported to the Administrator (ADM), and they were separated. SSD also stated that Resident 2 has expressed that she would like to be back with her spouse, Resident 1. During a review of Resident 1's Psychosocial Note, dated 8/15/2025, timed at 3:32 PM, Resident 1's Psychosocial Note indicated the Interdisciplinary Team (IDT; a group of diverse professionals from different disciplines who collaborate to achieve a common goal, typically by addressing complex issues for a patient) spoke with Resident 1 regarding the incident where Resident 2 was yelling and throwing papers at him. The note indicated Resident 1 had stated that he and Resident 2 should not be separated and that the argument was not a big deal. Resident 1 stated he felt safe with Resident 2 together in their room.During an interview on 8/28/2025 at 12:23 PM with ADM, ADM stated on 8/15/2025 Residents 1 and 2 were verbally notified of the room change and that he did unsubstantiate the allegation of verbal abuse between Residents 1 and 2. ADM stated that both Residents 1 and 2 have been expressing that they wanted to be back together and that they had both told the psychiatrist. ADM further stated that he understood that keeping the residents apart is a resident rights issue but decided to keep them apart as a safety precaution. During a review of Resident 2's Psychosocial Note dated 8/18/2025, Resident 2's Psychosocial Note indicated SSD and Social Services Assistant (SSA) spoke with Resident 2 and Resident 2 had asked them when she would be able to go back into her previous room with her spouse, Resident 1. SSD had told Resident 2 that the transfer back was still in question due to her tendency to argue with Resident 1. During a review of Resident 1's Initial Psychiatric Evaluation dated 8/18/2025, Resident 1's Initial Psychiatric Evaluation indicated Resident 1 stated he would like Resident 2 to return to their room as they were separated and also stated that he is sad Resident 2 is in another room and that he feels safe in the facility and would feel safe if Resident 2 would return.During a review of Resident 2's Initial Psychiatric Evaluation dated 8/18/2025, Resident 2's Initial Psychiatric Evaluation indicated Resident 2 stated she was upset and the incident of her yelling at him would not happen again and that she would like to return to the room with Resident 1. During a concurrent interview and record review on 8/28/2025 at 1 PM with the Director of Nursing (DON), Resident 1's Psychosocial Note, dated 8/15/2025, and timed at 3:32 PM and the facility's Policy and Procedure (P&P) titled, Resident Rights, revised December 2016 were reviewed. The Facility's P&P indicated, Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to: share a room with a spouse, if that is mutually agreeable. The DON stated if both Residents 1 and 2 had expressed that they wanted to be back together, then they should have been put back together. The DON further stated that since Resident 1 is Resident 2's responsible party, if they wanted to be back together, per policy it is their right.During an interview on 8/28/2025 at 1:21 PM with RNA 1, RNA 1 stated that since Residents 1 and 2 were first separated on 8/15/2025, Resident 1 had expressed to her multiple times that he would like to be back with Resident 2 in their room. During a review of the facility's P&P titled, Resident Rights, revised December 2016, the P&P indicated, Federal and state laws guarantee certain basic rights to all residents of this facility. These rights include the resident's right to: share a room with a spouse, if that is mutually agreeable. Event ID: Facility ID: 056063 If continuation sheet Page 3 of 3