Health inspection·December 12, 2025

F 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few readmit Resident 1 on [DATE]. The CMPN indicated on [DATE], the facility's DOBD stated that there were no male beds available until [DATE]. The CMPN indicated on [DATE], the facility's admission Coordinator (AC) stated Resident 1 did not have a bed-hold in the facility since [DATE]. The CMPN indicated on [DATE], the facility did not have beds available to readmit Resident 1 on [DATE] at 10:07 AM. During a telephone interview with Complainant 1 on [DATE] at 12 PM, Complainant 1 stated Resident 1 was still in GACH 1 because the facility stated there were no beds available to readmit Resident 1. During an observation on [DATE] at 3:14 PM, in the facility's Nursing Unit Station 2, Room A Bed B was vacant/unoccupied During an interview on [DATE] at 3:18 PM with Resident 2, Resident 2 stated Room A Bed B had been vacant since Resident 1 was transferred to GACH 2 on [DATE]. During an interview with the AC on [DATE] at 9:26 AM, the AC stated the AC verified insurance eligibility of the resident referred from GACH prior to admission. The AC stated the facility's Director of Nursing (DON) was responsible for reviewing the GACH inquiry and approving the admission along with the Administrator (ADM). The AC stated that the AC checked the bed availability in the facility using the Daily Census. The AC stated the residents had seven days' bed-hold to return to the same bed when they were transferred to GACH. The AC stated if the resident wished to return to the facility after the seven days' bed-hold, the facility should readmit the resident. The AC stated Resident 1's bed-hold expired on [DATE]. During a concurrent record review and interview with the AC on [DATE] at 9:26 AM, the AC 's cellphone group text with the facility's admission team dated [DATE] was reviewed. The group text indicated Resident 1's GACH 1 inquiry was forwarded to the ADM and DON on [DATE] at 10:59 AM. The AC stated the double check mark signs in the group text indicated the ADM and the DON were aware of Resident 1's inquiry. The AC stated the ADM, and the DON instructed the AC to verify Resident 1's insurance eligibility before re-admitting Resident 1. During a concurrent record review and interview with the AC on [DATE] at 9:26 AM, Resident 1's Insurance Eligibility Form (IEF) dated [DATE] was reviewed. The IEF indicated Resident 1 was eligible for Medi-Cal with M1 code. The AC stated the facility should have re-admitted Resident 1 regardless of the M1 code because Resident 1 was Medi-Cal eligible. The AC stated the AC was unable to verify Resident 1's insurance eligibility because of the M1 code on [DATE]. The AC stated the AC informed the ADM and the business office regarding Resident 1's M1 code on [DATE]. The AC stated Resident 1's insurance eligibility did not change since [DATE]. The AC stated, on [DATE], the ADM instructed the AC to hold on Resident 1's re-admission to the facility because of Resident 1's insurance eligibility with the M1 code. During a concurrent record review and interview with the AC on [DATE] at 9:26 AM, the facility's Daily Census dated [DATE] to [DATE], was reviewed. The AC stated the Daily Census indicated a bed was available for re-admitting Resident 1 from [DATE] to [DATE]. The AC stated the ADM instructed the AC to inform GACH 1 that the facility did not have available bed to re-admit Resident 1 on [DATE]. The AC stated, not readmitting back Resident 1 timely held Resident 1 up in GACH 1 unnecessarily. During an interview with the facility's DON on [DATE] at 11:16 AM, the DON stated the DON should have reviewed the GACH inquiry for Resident 1's re-admission right away and not to hold up the readmission process. The DON stated Room A Bed B was held for Resident 1 since [DATE], and no residents were admitted to it. The DON stated Room A Bed B was available to re-admit Resident 1 since [DATE]. During a concurrent record review and interview with the ADM on [DATE] at 12:21 PM, the facility's P&P titled admission and Orientation of Residents, revised [DATE], was reviewed. The P&P indicated The facility will not require a third-party guarantee of payment to the facility as a condition of admission or expedited admission or continued stay in the facility. The ADM stated the P&P indicated the facility should accept the resident back regardless of their insurance eligibility. The ADM stated it was important to readmit residents (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056118 If continuation sheet Page 2 of 5 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 056118 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gladstone Sub-Acute and Rehab Center 435 E. Gladstone St Glendora, CA 91740 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 0627 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete back to the facility because the residents were in the facility for long-term purposes and considered the facility as their home. The ADM stated it was the resident's right to be readmitted back to the facility from the GACH. The ADM stated the facility could not deny a resident even if the residents had issues with insurance eligibility. The ADM stated the M1 code indicated the resident was covered with full scope of Medi-Cal and the insurance coverage would change in 1/2026. The ADM stated, denying re-admission would have affected the residents' behavior, mood and general well-being. During a review of the facility's P&P titled Readmission, revised [DATE], the P&P indicated When the bed hold is not exercised or expires, residents will be permitted to return to their previous room, if available, or to the next available bed in a semi-private room. Event ID: Facility ID: 056118 If continuation sheet Page 3 of 5 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 056118 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gladstone Sub-Acute and Rehab Center 435 E. Gladstone St Glendora, CA 91740 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 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to provide the notices of discharge to the ombudsman (an advocate for residents of nursing homes, board and care centers, and assisted living facilities) in a timely manner for three of three sampled residents (Residents 1, 2, and 3) These deficient practices increased the risks of unsafe discharge and violation of resident's rights.Findings: a. During a review of Resident 1's admission Record (AR), the AR indicated Resident 1 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body) and bipolar disorder (sometimes called manic-depressive disorder; mood swings that ranged from the lows of depression to elevated periods of emotional highs). During a review of Resident 1's History and Physical (H&P) dated 10/9/2025, the H&P indicated Resident 1 did not have the capacity to understand and make decisions. During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool) dated 10/11/2025, the MDS indicated Resident 1 had severe cognitive impairment (confusion or memory loss). The MDS indicated Resident 1 was dependent (helper did all the effort) on staff with oral hygiene, personal hygiene, toileting hygiene, showering, and transferring. During a review of Resident 1's Physician Order (PO) dated 10/3/2025, the PO indicated to transfer Resident 1 to General Acute Care Hospital (GACH) on 10/3/2025 after a fall. During a review of Resident 1's Order Summary Report (OSR) as of 11/17/2025, the OSR indicated a PO to transfer Resident 1 to GACH for further evaluation on 11/17/2025 due to tachycardia (an abnormally fast heart rate) and desaturation (the oxygen level in the blood dropped below normal). During a review of Resident 1's Transmission Log (TL) dated 10/6/2025, the TL indicated Resident 1's Notice of Proposed Transfer/Discharge (NPTD) dated 10/3/2025 was faxed to the ombudsman on 10/6/2025. The TL indicated the copy of Resident 1's NPTD was mailed to Responsible Party (RP) 1 on 10/3/2025. During a concurrent record review and interview with Registered Nurse Supervisor 1 (RNS 1) on 12/12/2025 at 9:52 AM, Resident 1's TL dated 11/21/2025 was reviewed. RNS 1 stated the TL indicated the copy of the NPTD was mailed to Resident 1's RP 1 on 11/17/2025. RNS 1 stated the TL indicated the copy of the NPTD was sent to the ombudsman on 11/20/2025 and faxed on 11/21/2025. RNS 1 stated the facility notified the ombudsman late of Resident 1's discharge to GACH and should have done it immediately on 11/17/2025. RNS 1 stated the licensed nurses should complete and fax the NPTD to the ombudsman within the day of transfer. RNS 1 stated it was important to fax the NPTD to the ombudsman in a timely manner to ensure the information was up to date. b. During a review of Resident 2's AR, the AR indicated Resident 2 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including generalized muscle weakness and diabetes mellitus (DM, a disorder characterized by difficulty in blood sugar control and poor wound healing). During a review of Resident 2's H&P dated 11/7/2025, the H&P indicated Resident 2 had the capacity to understand and make decisions. During a review of Resident 2's MDS dated [DATE], the MDS indicated Resident 2 had intact cognition (ability to think and reason). The MDS indicated Resident 2 required supervision from staff for eating. The MDS indicated Resident 2 required partial assistance (helper did less than half the effort) from staff for oral hygiene and personal hygiene. The MDS indicated Resident 2 required maximal assistance (helper did more than half the effort) from staff for toileting hygiene and bed-to-chair transferring. The MDS indicated Resident 2 was dependent on staff for showering and tub/shower transferring. During a review of Resident 2's PO dated 12/2/2025, the PO indicated to transfer Resident 2 to GACH on 12/2/2025 due to difficulty swallowing. During a review of Resident 2's TL dated 12/3/2025, the TL indicated Resident 2's NPTD dated 12/3/2025 was faxed to the ombudsman on 12/3/2025. TL indicated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056118 If continuation sheet Page 4 of 5 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 056118 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Gladstone Sub-Acute and Rehab Center 435 E. Gladstone St Glendora, CA 91740 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 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Resident 2 received the NPTD on 12/2/2025. c. During a review of Resident 3's AR, the AR indicated Resident 3 was admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including metabolic encephalopathy (disease that affects the function or structure of the brain due to chemical imbalance in the body) and respiratory failure (a condition when the lungs cannot get enough oxygen into the blood). During a review of Resident 3's PO dated 11/15/2025, the order indicated to transfer Resident 3 to GACH on 11/15/2025 for blood transfusion (process of transferring blood of a person into the veins of another person). During a review of Resident 3's TL dated 11/15/2025, the TL indicated Resident 3's NPTD dated 11/15/2025 was faxed to the ombudsman on 11/17/2025. The TL indicated Resident 3 received the NPTD on 11/15/2025. During a review of Resident 3's PO dated 11/19/2025, the PO indicated to transfer Resident 3 to GACH on 11/19/2025 for evaluation and treatment for low hemoglobin and care of left leg wound. During a review of Resident 3's TL dated 11/21/2025, the TL indicated Resident 3's NPTD dated 11/19/2025 was faxed to the ombudsman on 11/21/2025. The TL indicated Resident 3 received the NPTD on 11/19/2025. During a review of Resident 3's H&P dated 11/23/2025, the H&P indicated Resident 3 had the capacity to understand and make decisions. During a review of Resident 3's MDS dated [DATE], the MDS indicated Resident 3 had intact cognition. The MDS indicated Resident 3 was independent with eating. The MDS indicated Resident 3 required supervision from staff for oral hygiene and personal hygiene. The MDS indicated Resident 3 required maximal assistance from staff for toileting hygiene and transferring. During a concurrent record review and interview with the Director of Nursing (DON) on 12/12/2025 at 11:16 AM, the facility's Policy and Procedure (P&P) titled Transfer or discharge, facility-initiated, revised on 4/1/2024, was reviewed. The P&P indicated The Ombudsman must also be notified as soon as practicable. The DON stated the P&P indicated to send out the NPTD to the ombudsman as soon as practicable, and it was not specific. The DON stated the P&P needed to be revised so the staff could follow. The DON stated the purpose of the NPTD was to notify the ombudsman of where the resident was transferred to. The DON stated it was important to notify the ombudsman at the time of residents' transfer and discharge. The DON stated the Medical Record Director (MRD) was responsible for faxing the NPTD to the ombudsman no later than the next day of transfer or discharge. During an interview with the MRD on 12/12/2025 at 12:18 PM, the MRD stated the MRD was responsible for faxing the NPTD to the ombudsman the next day of the transfer/ discharge. The MRD stated the MRD was busy and did not fax the NPTD to the ombudsman timely for Residents 1, 2, and 3. During a review of the facility's P&P titled Transfer or discharge, facility-initiated,, revised on 4/1/2024, the P&P indicated The Facility will also send a copy of the Notice of Proposed Transfer/Discharge to the State Long Term Care Ombudsman for a Facility-initiated discharge. The copy of the Notice of Proposed Transfer/Discharge must be provided to the Ombudsman at the same time the notice is provided to the resident or resident representative.A temporary transfer to an acute care facility is considered a facility-initiated discharge Event ID: Facility ID: 056118 If continuation sheet Page 5 of 5