Health inspection·September 16, 2025

F 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few 8/29/2025, the Braden Scale indicated Resident 2 was bedfast (confined to bed), slightly limited mobility, and moderately at risk for pressure sore. During a review of Resident 2's facility document titled Order Summary Report (OSR) dated 8/29/2025, indicated a physician's order for wound consult and follow up visit by skilled wound care weekly, day shift Thursday Skilled Wound Care (SWC) (company that sends wound MD to facilities for wound evaluation and treatment). During a review of Resident 2's Minimum Data Set (MDS, a resident assessment tool), dated 9/5/2025, the MDS indicated Resident 2's cognitive skills (ability to make daily decisions) were severely impaired. The MDS indicated Resident 2 required supervision or touching assistance (Helper provides verbal cues and or touching steadying) with eating, and substantial/maximal assistance (helper does more than half the effort) with bathing, toileting, personal hygiene and dressing. During an observation on 9/16/2025 at 11:30 AM while in Resident 2's room, Resident 2 was in bed on his back, with limited mobility, verbalizing words making little or no sense. During a concurrent interview and record review, on 9/16/2025, at 2:30 PM, with Treatment Nurse (TN) 1, the (undated) facility binder for Skilled Wound Care (SWC) Communication Log was reviewed, the binder did not have a weekly assessment from WMD or TN 1 of Resident 2's Stage 3 PI on the sacrum area, and the SDTPI on Resident 2's right and left heel. TN 1 stated he did not have a weekly assessment of Resident 2's PI ‘s because he forgot to tell the WMD. TN 1 stated Resident 2 PI's were not reported to the WMD for evaluation, management and treatment and was not evaluated weekly by the WMD as per the plan of care. TN 1 stated, Resident 2 missed two weekly assessments, on 9/4/2025 and 9/11/2025. TN 1 stated it is important for WMD to assess and evaluate Resident 2's PI's to make sure if the wound is getting better or not, and to ensure proper treatment was being used, due to potential for the PI's to worsened. During a concurrent interview and record review, on 9/16/2025, at 3 PM, with the Director of Nurses (DON), Resident 2's electronic medical record (EMR -a collection of medical information about a person that is stored on a computer) from 8/29/2025 until present was reviewed. EMR did not indicate Resident 2 was evaluated by WMD or had a weekly assessment by WMD. DON stated, the facility did not have any documentation of WMD initial wound assessment or weekly assessment of Resident 2's PI's as per plan of care. During an interview on 9/16/2025, at 3:30 PM with the DON, the DON stated the facility did implement the plan of care for Resident 2's PI's. The DON stated the WMD as well as TN 1 did not have a weekly assessment. The DON stated not having a weekly assessment of Resident 2 PI's had the potential to result in the worsening of Resident 2's PI's, by not having a WMD evaluate the pressure injury and effectiveness of current treatments, which could affect Resident 2's quality of life. A review of the facility's policy and procedure (P&P) titled, Prevention of Pressure Injuries, revised on 4/2020, indicated the following: a) the policy's purpose is to provide information regarding identification of pressure injury risk factors and interventions for specific risk factors, b) review the resident's care plan and identify the risk factors as well as the interventions designed to reduce or eliminate those considered modifiable, c) assess resident on admission for existing pressure injury risk factors, repeat the risk assessment weekly and upon changes of condition, and evaluate, report and document potential changes in skin, review the interventions and strategies for effectiveness on an ongoing basis. A review of the facility's policy and procedure (P&P) titled, Pressure Ulcers/Skin Breakdown - Clinical Protocol, revised on 4/2020, indicated a) the nursing staff and practitioner will assess and document an individuals significant risk factors for developing pressure ulcer, b) the staff and the practitioner will examine the skin of newly admitted residents for evidence of existing pressure ulcers or other skin conditions, c) the physician will help staff characterize there likelihood of wound healing based on the review of pertinent factors, and d) the physician will identify medical interventions related to (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056111 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 056111 B. Wing A. Building (X3) DATE SURVEY COMPLETED 09/16/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Griffith Park Healthcare Center 201 Allen Ave. Glendale, CA 91201 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete wound management. A review of the facility's policy and procedure (P&P) titled, Care Plans, Comprehensive Person - Centered, revised on 12/2016, indicated; a) a comprehensive care plan that includes measurable objectives and timetables to meet the resident's physical and functional needs is developed and implemented for each resident, b) comprehensive, person centered care plan will described services that are to be furnished to attain or maintain highest practicable physical, mental wellbeing, and include resident stated goals upon admission and desired outcomes. Event ID: Facility ID: 056111 If continuation sheet Page 3 of 3