Health inspection·July 22, 2025

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 ensure three of three residents (Resident 1, 2 and 3) were provided with a discharge summary that included recapitulation (Recap - describes the resident's course of treatment while residing in the facility) of the residents' stay and complete, appropriate discharge information and instructions to ensure safe and orderly discharge from the facility. This deficient practice had the potential to result in unsafe discharge, incomplete documentation of the resident's transfer or discharge in the resident's medical record, and inadequate communication of necessary discharge information to the resident or their representative.a. During a review of Resident 1's admission Record, the admission Record indicated the facility admitted Resident 1 on 3/19/2025 with diagnoses including hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body) and hemiparesis (paralysis or weakness on one side of the body) following cerebral infarction (CI - a serious medical condition that occurs when blood flow to the brain is blocked, leading to brain cell death) affecting right dominant (more powerful, controlling, or noticeable than other things) side. The admission Record further indicated Resident 1 was discharged on 6/30/2025 to a private home with no home health services. During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool) dated 6/30/2025, the MDS discharge assessment indicated Resident 1's cognitive (the mental action or process of acquiring knowledge and understanding through thought, experience, and senses) skills for daily decision making were intact. The MDS indicated that Resident 1 was independent with eating, oral/personal hygiene and bed mobility (movement), needed setup or clean-up assistance for chair/bed-to-chair transfer and walking 10 feet, and needed supervision or touching assistance for toileting hygiene and toilet transfer. The MDS further indicated Resident 1 was always continent both urine and bowel. During a review of Resident 1's physician order dated 6/27/2025, the physician order indicated to discharge Resident 1 to home on 6/30/2025.During a review of Resident 1's Interdisciplinary (working together to solve complex problems) Care Conference notes dated 6/26/2025, the notes indicated Resident 1 was being discharged on 6/30/2025, and the physician was notified to order Home Health (HH) services and rollator walker (RW - a walking aid with wheels, brakes and a seat, designed for people who need help with balance and walking).During a review of Resident 1's Physical Therapy (PT) Discharge summary dated [DATE], the PT Discharge Summary indicated that the discharge recommendations were home exercise program and HH services.During a review of Resident 1's Post Discharge Plan of Care and Summary (discharge summary) dated 6/30/2025 timed at 3:50 a.m., the Post Discharge Plan of Care and Summary indicated that the facility provided Resident 1's discharge summary to family (FM 2) on 6/30/2025 upon Resident 1's discharge. The discharge summary did not indicate recapitulation of Resident 1's stay, and discharge information for the areas of Therapy Services, Dietary Services, Social Services, and Activities Services. The discharge summary further indicated Resident 1's bladder (urine) and bowel continent status were incontinent Page 1 of 6 056124 056124 07/22/2025 Tarzana Health and Rehabilitation Center 5650 Reseda Blvd Tarzana, CA 91356

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some (lose control over your bladder or bowels and leaking urine or feces), and Resident 1 needed assistance with eating, oral hygiene, and bed mobility. During an interview on 7/17/2025 at 2:54 p.m., with FM 1, FM 1 stated that the facility provided FM 1 incomplete discharge summary because it did not indicate the contact information of the HH services company (HH1) that would be providing HH services to Resident 1 at home. FM 1 stated HH 1 did not provide services to Resident 1 at home after the resident was discharged , so FM 1 had to independently arrange for a different HH services company one week (7/7/2025) after Resident 1 was discharged . FM 1 stated Resident 1 was not discharged with a walker, which was essential due to the resident's unsteady gait and fall risk. FM 1 further stated the discharge summary indicated that Resident 1 needed to be referred to a placement to lower level of care, specifically an independent living facility, which FM1 stated was inaccurate. During a concurrent interview and record review on 7/18/2025 at 2:15 p.m., with Registered Nurse 1 (RN 1), reviewed Resident 1's Discharge summary dated [DATE], electronically signed by RN 3. RN 1 stated that Resident 1's discharge summary did not contain the recap of the resident's stay or discharge information for Therapy Services, Dietary Services, Social Services, and Activities Services.During a concurrent interview and record review on 7/22/2025 at 12:33 p.m., with Social Services Assistant 1 (SSA 1) reviewed Resident 1's Discharge summary dated [DATE]. SSA 1 stated SSA 1 filled out the discharge summary prior to Resident 1's discharge, however, the discharge summary printed on 6/30/2025 from the system printed out the wrong discharge summary without the recapitulation of the resident's stay or complete discharge information.During a further interview and record review on 7/22/2025 at 12:54 p.m., with SSA 1 reviewed the facility facsimile (Fax - transmits a printed document electronically from one place to another) transaction record dated 7/22/2025 indicating that SSA 1 faxed the referral of HH services to HH 1 at 12:01 p.m. on 7/22/2025. SSA 1 stated that the first referral fax confirmation or documentation which included the discharge home order dated 6/30/2025 with instructions for HH services from HH1 and rollator walker might have been shredded mistakenly.During a concurrent interview and record review on 7/22/2025 at 1:53 p.m., with the Minimum Data Set Nurse 1 (MDSN 1) reviewed Resident 1's Discharge summary dated [DATE] and the MDS discharge assessment dated [DATE]. MDSN 1 stated they gathered the relevant information based on the look back periods from the assessment day (6/30/2025) by observing the resident, interviewing the assigned nurses, and the nurses' notes. MDSN 1 stated that the resident's continent status and functional status should match the information indicated on the discharge summary and the MDS discharge assessment. MDSN 1 stated the discharge summary should have indicated Resident 1 was continent with bowel and bladder independent with oral/personal hygiene, and bed mobilityb. During a review of Resident 2's admission Record, the admission Record indicated the facility admitted Resident 2 on 6/14/2025 with diagnoses including right acetabular (the socket of hip joint) fracture (broken bone) and history of falling. The admission Record indicated the Resident 2 was discharged to a private home on 6/25/2025 private home with no home health services.During a review of Resident 2's MDS dated [DATE], the MDS discharge assessment indicated Resident 2's cognitive skills for daily decision making were intact. The MDS indicated that Resident 2 needed moderate assistance for toileting hygiene, shower, lower body dressing, and needed supervision or touching assistance for eating, oral hygiene and bed mobility, transferring, and walking. The MDS further indicated Resident 2 was occasionally incontinent of urine.During a review of Resident 2's Order Summary Report dated 6/25/2025, the physician order indicated an order to discharge the resident to home on 6/25/2025 under HH services with physical/occupational therapy and Durable Medical Equipment (DME medical devices and supplies) including walker, wheelchair, and commode.During a concurrent interview and record review on 7/18/2025 at 1:10 p.m., with RN 1 reviewed Resident 2's 056124 Page 2 of 6 056124 07/22/2025 Tarzana Health and Rehabilitation Center 5650 Reseda Blvd Tarzana, CA 91356

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Discharge summary dated [DATE] signed by the recipient without a date. RN 1 stated that Resident 2's discharge summary did not contain the recapitulation of the resident's stay or discharge information for Therapy Services, Social Services, and Activities Services. RN 1 stated RN 1 documented in the discharge summary Resident 2 was incontinent with bowel and bladder, however, the MDS dated [DATE], indicated Resident 2 was occasionally incontinent with bladder. RN 1 further stated she documented Resident 2's functional status was independent, however, the MDS dated [DATE] indicated Resident 2 required moderate assistance for toileting hygiene, shower, lower body dressing, and needed supervision or touching assistance for eating, oral hygiene and bed mobility, transferring, and walking. RN 1 stated that she only interviewed the resident on the day of the discharge and did speak with the assigned nurses or review the nursing [NAME]. RN 1 further stated RN 1 did not indicate the equipment needed at home, and as result Resident 2's discharge summary did not have accurate and complete information. c. During a review of Resident 3's admission Record, the admission Record indicated the facility admitted Resident 3 on 4/23/2025 with diagnoses including multiple sclerosis (MS- a chronic, progressive disease involving damage to the nerve cells in the brain and spinal cord) and right femur (thigh bone) fracture. The admission Record further indicated the date of discharge was 7/16/2025 and Resident 3 was discharged to private home with no home health services.During a review of Resident 3's MDS dated [DATE], the MDS discharge assessment indicated Resident 3's cognitive skills for daily decision making were intact. The MDS indicated that Resident 3 needed moderate assistance for toileting/personal hygiene, shower, lower body dressing, and needed supervision or touching assistance for bed mobility, transferring, and walking. The MDS further indicated Resident 3 was always incontinent with bowel and bladder.During a review of Resident 3's physician order dated 7/16/2025, the physician order indicated to discharge Resident 3 to home on 7/16/2025 with HH 2 services of RN/physical/occupational therapy and DME including rollator walker and bedside commode.During a concurrent interview and record review on 7/18/2025 at 2:55 p.m., with RN 2, reviewed Resident 3's chart and stated that the copy of Resident 3's discharge summary given to the resident or the resident's family with the recipient's acknowledgement should be stored in the chart, but RN 2 was unable to locate it. RN 2 stated that the facility could not provide proof that written discharge summaries were provided to Resident 3 upon discharge, without documentation of the recipient's acknowledgement. RN 2 reviewed the progress note written by RN 2 on 7/16/2025 and stated that he did not document that the discharge summary was given to the resident or the resident's family.During a concurrent interview and record review on 7/17/2023 at 5:07 p.m., with the Director of Nursing (DON) reviewed Resident 3's chart including progress notes dated 7/16/2025. The DON the DON was unable locate the documentation indicating the discharge summary was given to the resident or the resident's family upon the resident's discharge. The DON stated that the facility did not place copies of Resident 3's discharge summary with the recipient's acknowledgement in the chart, and did not document in the progress notes that the discharge summary was given to the resident or the resident's family.During a review of the facility's policy and procedure (P&P) titled, Discharge Summary last reviewed 4/24/2025, the P&P indicated, The discharge summary provides the necessary information to continuing in care providers pertaining to the course of treatment while the resident was in the facility and the resident's plan for care after discharge. It must include an accurate and current description of the clinical status of the resident and sufficiently detailed, individualized care instructions, to ensure that care is coordinated and the resident traditions safely from one setting to another. For residents discharged to their home, the medical record should contain documentation that written discharge instructions were given to the resident and if applicable, the resident representative. These instructions must be 056124 Page 3 of 6 056124 07/22/2025 Tarzana Health and Rehabilitation Center 5650 Reseda Blvd Tarzana, CA 91356

F 0628 discussed with the resident and the resident representative and conveyed in a language and manner they will understand. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some 056124 Page 4 of 6 056124 07/22/2025 Tarzana Health and Rehabilitation Center 5650 Reseda Blvd Tarzana, CA 91356

F 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. 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 provide medically related social services (services provided by the facility's staff to assist residents in attaining or maintaining their mental and psychosocial health) to maintain the highest practicable psychosocial well-being for one of three sampled residents (Resident 1) when the social services department did not arrange home health services (HH) and provide a walker to Resident 1 upon discharge. This deficient practice had the potential to negatively affect the resident's continuity of care and safety during the transition from facility to home.Findings: During a review of Resident 1's admission Record, the admission Record indicated the facility admitted Resident 1 on 3/19/2025 with diagnoses including hemiplegia (total paralysis of the arm, leg, and trunk on the same side of the body) and hemiparesis (paralysis or weakness on one side of the body) following cerebral infarction (CI - a serious medical condition that occurs when blood flow to the brain is blocked, leading to brain cell death) affecting right dominant (more powerful, controlling, or noticeable than other things) side. The admission Record further indicated Resident 1 was discharged on 6/30/2025 to a private home with no home health services. During a review of Resident 1's Minimum Data Set (MDS - a resident assessment tool) dated 6/30/2025, the MDS discharge assessment indicated Resident 1's cognitive (the mental action or process of acquiring knowledge and understanding through thought, experience, and senses) skills for daily decision making were intact. The MDS indicated that Resident 1 was independent with eating, oral/personal hygiene and bed mobility (movement), needed setup or clean-up assistance for chair/bed-to-chair transfer and walking 10 feet, and needed supervision or touching assistance for toileting hygiene and toilet transfer. The MDS further indicated Resident 1 was always continent both urine and bowel. During a review of Resident 1's physician order dated 6/27/2025, the physician order indicated to discharge Resident 1 to home on 6/30/2025.During a review of Resident 1's Interdisciplinary (working together to solve complex problems) Care Conference notes dated 6/26/2025, the notes indicated Resident 1 was being discharged on 6/30/2025, and the physician was notified to order Home Health (HH) services and rollator walker (RW - a walking aid with wheels, brakes and a seat, designed for people who need help with balance and walking).During a review of Resident 1's Physical Therapy (PT) Discharge summary dated [DATE], the PT Discharge Summary indicated that the discharge recommendations were home exercise program and HH services.During a review of Resident 1's Post Discharge Plan of Care and Summary (discharge summary) dated 6/30/2025 timed at 3:50 a.m., the Post Discharge Plan of Care and Summary indicated that the facility provided Resident 1's discharge summary to family (FM 2) on 6/30/2025 upon Resident 1's discharge. The discharge summary did not indicate recapitulation of Resident 1's stay, and discharge information for the areas of Therapy Services, Dietary Services, Social Services, and Activities Services. During an interview on 7/17/2025 at 2:54 p.m., with FM , FM 1 stated that the facility provided FM 1 incomplete discharge summary because it did not indicate the contact information of the HH services company (HH1) that would be providing HH services to Resident 1 at home. FM 1 stated HH 1 did not provide services to Resident 1 at home after the resident was discharged , so FM 1 had to independently arrange for a different HH services company one week (7/7/2025) after Resident 1 was discharged . FM 1 stated Resident 1 was not discharged with a walker, which was essential due to the resident's unsteady gait and fall risk. FM 1 further stated the discharge summary indicated that Resident 1 needed to be referred to a placement to lower level of care, specifically an independent living facility, which FM1 stated was inaccurate. During a concurrent interview and record review on 7/18/2025 at 2:15 p.m., with Registered Nurse 1 (RN 1), reviewed Resident 1's Discharge summary Residents Affected - Few 056124 Page 5 of 6 056124 07/22/2025 Tarzana Health and Rehabilitation Center 5650 Reseda Blvd Tarzana, CA 91356

F 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few contain the recap of the resident's stay or discharge information for Therapy Services, Dietary Services, Social Services, and Activities Services.During a concurrent interview and record review on 7/22/2025 at 12:33 p.m., with Social Services Assistant 1 (SSA 1) reviewed Resident 1's Discharge summary dated [DATE]. SSA 1 stated SSA 1 filled out the discharge summary prior to Resident 1's discharge, however, the discharge summary printed on 6/30/2025 from the system printed out the wrong discharge summary without the recapitulation of the resident's stay or complete discharge information.During a further interview and record review on 7/22/2025 at 12:54 p.m., with SSA 1 reviewed the facility facsimile (Fax - transmits a printed document electronically from one place to another) transaction record dated 7/22/2025 indicating that SSA 1 faxed the referral of HH services to HH 1 at 12:01 p.m. on 7/22/2025. SSA 1 stated that the first referral fax confirmation or documentation which included the discharge home order dated 6/30/2025 with instructions for HH services from HH1 and rollator walker might have been shredded mistakenly.During a review of the facility's policy and procedure (P&P) titled, Social Services last reviewed 4/24/2025, the P&P indicated, The social worker, or social services and designee, will pursue the provision of any identified need for medically related social services of the resident. Transitions of care services (e.g., assisting the resident with the identifying community placement options and completion of the application process, arranging intake for home care services for residents returning home, assisting with transfer arrangement to other facilities). 056124 Page 6 of 6