Health inspection·August 22, 2025

F 0755 Level of Harm - Minimal harm or potential for actual harm any time if they feel a clinical situation requires immediate discussion and management.Non-immediate Notification Situations. However, do not wait if there is concern or reason to believe that the situation requires more urgent discussion. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056066 If continuation sheet Page 2 of 4 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 056066 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodland Care Center 7120 Corbin Ave. Reseda, CA 91335 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on interview and record review, the facility failed to maintain complete and accurate medical records in accordance with accepted professional standards for one of four sampled residents (Resident 1) by failing to accurately document Resident 1's blood pressure (BP - a measure of how well blood circulates through your arteries [pathway that carries blood away from the heart]).This deficient practice placed the resident at risk of not receiving appropriate care due to inaccurate resident medical care information and the potential to result in confusion in the care and services for Resident 1.During a review of Resident 1's admission Record, the admission Record indicated the facility admitted Resident 1 on 3/24/2025 and readmitted the resident on 6/12/2025 with diagnoses that included Parkinson's disease (a movement disorder of the nervous system that worsens over time), hypotension (low blood pressure), and bipolar disorder (mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks).During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool) dated 5/5/2025, the MDS indicated Resident 1 was able to make self-understood and understand others, and Resident 1's cognition (ability to think and make decisions) was intact. The MDS further indicated that Resident 1 was independent for activities of daily livings (ADLs- activities such as bathing, dressing and toileting a person performs daily).During a review of Resident 1's Order Summary Report dated 8/21/2025, the Order Summary Report indicated the following orders:- Record standing BP, again after three (3) minutes. Standing BP at 10 a.m., 12:30 p.m., and 5:30 p.m., three times a day. Order date: 3/26/2025.- Midodrine hydrochloride (used to treat the symptoms of low BP caused by a changing position or standing), give 10 milligram (mg- unit of measurement) by mouth three times a day related to hypotension (low blood pressure), hold for systolic BP (SBP - the first number in a blood pressure reading, which measures the pressure in the arteries when the heart beats) greater than 120, call the physician immediately if SBP is less than 90. Order date 8/7/2025. During a review of Resident 1's Medication Administration Record (MAR - a daily documentation record used by a licensed nurse to document medications and treatments given to a resident) dated 8/2025, the MAR indicated the following:- On 8/1/2025 at 5 p.m., Resident 1's standing BP was 66/58 millimeters of mercury (mmHg- unit of measurement for BP).- On 8/8/2025 at 5 p.m., Resident 1's standing BP was 53/39 mmHg.During a review of Resident 1's Weights and Vitals Summary, the Weights and Vitals Summary indicated the following:- On 8/8/2025, Resident 1's sitting BP was 80/56 mmHg at 8:44 p.m., Resident 1's standing BP was 53/39 mmHg at 8:45 p.m., and Resident 1's sitting BP was 80/56 mmHg at 8:46 p.m. During a concurrent phone interview and record review on 8/21/2025 at 3:50 p.m., with Licensed Vocational Nurse 2 (LVN 2), reviewed Resident 1's Weights and Vitals Summary. Informed LVN 2 that LVN 2 documented Resident 1's BPs on 8/8/2025 was 80/56 mmHg at 8:44 p.m., 53/39 mmHg at 8:45 p.m., and 80/56 mmHg at 8:46 p.m. LVN 2 stated that Resident 1's BPs were not that low and entered the wrong readings mistakenly, but LVN 2 did not know how to correct it by striking out the documentation and was so busy to correct Resident 1's BP readings on that day (8/8/2025). LVN 2 further stated that Resident 1 took midodrine to elevate low BPs, but still if Resident 1's BPs were that low then LVN 2 should call the physician to notify about Resident 1's low BPs but Resident 1 never had any episodes of SBP below 90.During a concurrent interview and record review on 8/21/2025 at 4:26 p.m., with the Director of Nursing (DON), reviewed Resident 1's Weights and Vitals Summary. The DON stated that LVN 2 should correct the wrong data entered, and if they do not know how to correct it, then LVN 2 should ask an RN supervisor or other licensed nurses. The DON stated if licensed nurses do not correct the data entered mistakenly in a timely manner, especially BP readings, it would make (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056066 If continuation sheet Page 3 of 4 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 056066 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/22/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Woodland Care Center 7120 Corbin Ave. Reseda, CA 91335 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete the staff confused regarding a resident's condition or the services delivered. During a concurrent phone interview and record review on 8/22/2025 at 3:56 p.m., with LVN 2, reviewed Resident 1's MAR dated 8/2025. Informed LVN 2 that LVN 2 documented that Resident 1's standing BP was 66/58 mmHg on 8/1/2025 at 5 p.m. LVN 2 stated that Resident 1's SBP was never lower than 90 and it was entered mistakenly. LVN 2 was unable to recall Resident 1's BP on 8/1/2025 but if it was that low, LVN 2 should initiate a Change of Condition (COC - any significant, sudden deviation from a resident's normal physical, mental, cognitive, or functional status) and notify the physician. LVN 2 stated Resident 1's low BP was entered mistakenly and LVN 2 did not learn how to correct in the MAR. During a review of the facility's policy and procedure (P&P) titled, Blood Pressure, Measuring, last reviewed on 1/16/2025, the policy indicated, Hypotension is defined as blood pressure less than 100/60 millimeters of mercury. Nurse should review if there are any medications ordered for hypotension and administer as ordered. Recheck blood pressure then notify if blood pressure remains low. The following information should be recorded in the resident's medical record: the blood pressure reading.Report other information in accordance with facility policy and professional standards of practice. Event ID: Facility ID: 056066 If continuation sheet Page 4 of 4