Health inspection·October 10, 2025

F 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few No room changes were needed because both rooms are in separate hallways far away from each other. 2. On 10/7/2025, Resident 1 was assessed by the licensed nurse, Director of Nursing, and Social Services Director (SSD). Emotional support and reassurance were provided to Resident 1. 3. On 10/7/2025, the Registered Nurse (RN, not specified) communicated with Resident 1's Physician (MD) and family. MD expressed confidence and agreement with continued care at the facility. The DON obtained MD orders for Psychologist (a health practitioner that specializes in the study of mind and behavior or in the treatment of mental, emotional, and behavioral disorders) evaluation, monitor for any potential emotional or mood changes such as sudden mood changes, irritability, withdrawal, sadness, anxiety (fear characterized by behavioral disturbances), emotional outbursts related to alleged incident involving another resident. The licensed nurses will document Resident 1's monitoring in the Medication Administration Record (MAR, a daily documentation record used by a licensed nurse to document medications and treatments given to a resident).4. On 10/7/2025, the DON obtained MD order for Resident 2 to be placed on one (1) to 1 supervision (1:1 supervision, an intervention when a nurse or healthcare professional provides constant observation and support to a resident who is at risk of harm, such as one with cognitive [mental action or process of acquiring knowledge and understanding] impairments, challenging behaviors, or one who may fall or cause harm to himself/herself or to others) for safety and close monitoring. On 10/8/2025 the Psychologist evaluated Resident 2, and the Psychologist stated Resident 2 remained calm and stable. The Psychologist will visit Resident 2 weekly to determine if 1:1 supervision is still needed. Resident 2 will remain on 1:1 supervision for safety until the Psychologist determines the resident is clinically stable. Additionally, the 1:1 supervision will be documented on a monitoring log (Activity/Visual Monitoring Log). 5. On 10/7/2025, the RN notified Resident 2's family and MD. The MD confirmed that Resident 2's current placement is appropriate. The DON obtained orders from MD to monitor Resident 2 for potential triggers that could result in inappropriate action or physical contact. The order also included ensuring redirection (technique used in health care setting to shift a person's focus away from a distressing situation and/ or used to manage challenging behaviors like agitation by diverting attention to a calmer or more positive activity), prioritizing safety and notifying the MD of any episodes. Licensed nurses will be responsible for monitoring every shift and document in the MAR. 6. On 10/7/2025, Resident 1 was evaluated by Psychiatrist (a health practitioner that specializes in the diagnosis and treatment of mental illness). According to the Psychiatrist's evaluation Resident 1 did not have behavioral changes noted. The Psychiatrist made recommendations to continue to monitor Resident 1.7. Effective 10/7/2025, Resident 2 will remain on 1:1 supervision and followed by the Psychologist weekly for four weeks to provide ongoing psychosocial support and behavior monitoring. Social Services will provide psychosocial (relating to the interrelation of social factors and individual thought and behavior) support and daily visits for 72 hours then weekly thereafter for 8 weeks for Resident 1 and 2.8. On 10/7/2025, Resident 2 was evaluated by the Psychiatrist. According to the Psychiatrist's evaluation, Resident 2 did not display mood or safety concern. The Psychiatrist made recommendations to continue to monitor Resident 2.9. On 10/8/2025, Resident 1 was evaluated by the Psychologist with no mood changes. The Psychologist made recommendations for Psychologist's visits for weekly evaluations until further notice. 10. On 10/8/2025, the Psychologist evaluated Resident 2 and determined that Resident 2's behavior is stable and will continue weekly visits until further notice. Resident 2 will remain on 1:1 supervision until the Psychologist determines Resident 2 is stable.11. On 10/9/2025, Facility initiated hallway monitoring to ensure Resident 1 and 2 remain separated.12. On 10/9/2025, Interdisciplinary Team (IDT, means a group of professional and direct care staff that have primary responsibility for the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056127 If continuation sheet Page 2 of 6 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 056127 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Live Oak Rehab Center 537 W Live Oak San Gabriel, CA 91776 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few development of a plan for the care and treatment of a patient) conducted a care plan (a comprehensive document that outlines the specific healthcare needs, goals, and interventions for a resident) meeting with Resident 2's family members' and updated the care plan interventions as follows: Continue 1:1 supervision until the Psychologist determines Resident 2 is clinically stable. The Psychologist will continue the weekly visit for four (4) weeks then monthly. Monitor Resident 2 for potential triggers that could result in inappropriate actions or physical contact.13. On 10/9/2025, the ADM, the DON, and Director of Staff Development (DSD) notified the facility staff (all staff- licensed nurses, certified nurse assistant (CNAs), department staff, housekeeping, and dietary) of the IJ findings and initiated an Abuse Prevention in-service covering: Identification of situations where abuse, neglect (the failure of the facility, its employees or service providers to provide goods and services to a resident that are necessary to avoid physical harm, pain, mental anguish or emotional distress), or misappropriation of property (the deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's belongings or money without the resident's consent) may occur to prevent abuse. Protection of residents from abuse. Immediate intervention, correction, and mandatory reporting of abuse.14. As of 10/10/2025, 122 out of 135 active staff members have received the abuse prevention in-service. 13 active staff members are currently on leave of absence and will receive the training prior to returning to duty.15. On 10/9/2025, the ADM notified the Medical Director and Clinical Consultant of the IJ findings. On 10/10/2025, The Medical Director and Clinical Consultant reviewed and approved the IJ Removal Plan.16. On 10/9/2025, the SSD, Social Services Assistant (SSA) and Minimum Data Set Nurse (MDSN, nurse who specializes in collecting, analyzing, and documenting patient data) conducted interviews with all alert and oriented residents to assess any concerns related to abuse. For residents unable to be interviewed due to cognitive or physical limitations, behavioral and facial expressions observations were conducted. There were no reports of abuse, neglect, or mistreatment identified among any residents.17. On 10/10/2025, after re-assessment, the DON confirmed that there are only 3 residents (Residents 1, 3, and 4) who are wanderers and cognitively impaired which may make them vulnerable for abuse. On 10/20/2025, the DON updated Residents 1, 3 and 4 ‘s care plan to include hourly whereabouts monitoring and documented in the MAR to address their wandering risk.18. Effective 10/9/2025, the RN or designee will conduct 30-minute safety rounds every shift for 90 days throughout the facility hallways to ensure all residents are safe and free from abuse. The monitoring will be documented in the Hallway Monitoring log for 90 days. 19. Effective 10/9/2025, the ADM and the DON will conduct monthly abuse prevention in-services for three months, reinforcing the following: Recognition of situations where abuse, neglect, or misappropriation of resident's property may occur to prevent abuse and protection of residents from abuse. Immediate intervention, correction, and reporting of abuse requirements.20. Effective 10/9/2025, discussion of abuse prevention compliance and resident safety including any concerns related to behavioral triggers and wandering to ensure residents are free from abuse will be a standing agenda item in the daily stand-up meetings to ensure ongoing communication and staff accountability.21. On 10/9/2025, the DON created Daily Abuse Prevention Monitoring Log to identify and document any situations where abuse, neglect or misappropriation of resident property, safety rounds and staff compliance checks. This monitoring log will be used during the ADM and the DON's daily rounds which include the date, resident's name, room number and specific findings/concerns, along with any necessary follow-up action22. The ADM and the DON are responsible for reviewing the hallway monitoring logs daily and submitting summaries to the Quality Assessment and Assurance (QAA, to develop and implement appropriate plans of action to correct identified quality deficiencies) Committee (a group in healthcare settings, particularly (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056127 If continuation sheet Page 3 of 6 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 056127 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Live Oak Rehab Center 537 W Live Oak San Gabriel, CA 91776 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few nursing homes, that oversees a facility's Quality Assurance and Performance Improvement [QAPI, data driven approach to improve the quality of care and safety in nursing homes] program) for review and follow-up.23. The Administrator, DON, or RN Supervisor will make daily facility rounds x 90 days to ensure staff's adherence to the Abuse Prevention Program. Findings and corrective actions will be documented on the monitoring log.24. The facility has initiated a QAPI Project for Abuse Prevention. The QAPI Committee will review compliance and outcomes monthly for three months and revise interventions as necessary to ensure ongoing effectiveness and sustainability. Findings: 1. During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was originally admitted to the facility on [DATE], and readmitted on [DATE] with diagnoses that included dementia (a progressive state of decline in mental abilities), gastrostomy (a surgical opening fitted with a device to allow feedings to be administered directly to the stomach common for people with swallowing problems) and metabolic encephalopathy (disease affecting how brain works). During a review of Resident 1's Minimum Data Set (MDS, a resident assessment tool), dated 8/6/2025, the MDS indicated Resident 1's cognitive skills for daily decision making was severely impaired (never/rarely made decisions). The MDS indicated Resident 1 was dependent (helper does all the effort) with oral hygiene, toileting hygiene, shower, upper body dressing, lower body dressing, putting on/taking off footwear and personal hygiene. The MDS indicated Resident 1 required supervision (helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity) once seated in wheelchair and while wheeling herself at least 150 feet. During a review of Resident 1's Change of Condition (COC, significant change in resident's status that requires intervention) assessment form dated 10/7/2024, timed 1:30 PM, the COC indicated a family member (Visitor 1) reported to nursing staff that Visitor 1 had witnessed another resident inappropriately touching Resident 1. During a review of Resident 1's Psychiatry Progress note dated 10/7/2025, reason for consult indicated urgent for abuse allegations. The note indicated per reports from other resident's family member (Visitor 1), Resident 2 touched Resident 1 inappropriately while Resident 1 is sitting in the wheelchair. 2. During a review of Resident 2's admission Record, the admission Record indicated Resident 2 was admitted to the facility on [DATE] with diagnoses that included dementia, major depressive disorder (a mood disorder that causes a persistent feeling of sadness and loss of interest), and chronic obstructive pulmonary disease (COPD-a chronic lung disease causing difficulty in breathing. During a review of Resident 2's MDS, dated [DATE], the MDS indicated Resident 2's cognitive skills for daily decision making was moderately impaired (decisions poor, cues/supervision required). The MDS indicated Resident 2 was independent (resident completes the activity by themselves with no assistance from a helper) with oral hygiene and personal hygiene. The MDS indicated Resident 2 required set up or clean up assistance (helper sets up or cleans up, resident completes activity) with eating, upper body dressing, lower body dressing, putting on/taking off footwear and walking at least 50 feet to 150 feet in a corridor or similar space. During a review of Resident 2's COC dated 10/7/2025, timed at 1:25 PM, the COC indicated a situation of alleged inappropriate touching another resident (details not specified). Licensed Vocational Nurse 1 (LVN 1) documented LVN 1 was notified by Visitor 1 that Resident 2 was seen touching another resident's breast in the hallway. During a review of Resident 2's order listings for the month of October 2025, an order of one-to-one monitoring, every shift was ordered on 10/7/2025 at 5:22 PM. During a review of undated Visitor 1's documented witness statement, the witness statement indicated the following: On 10/7/2025, Tuesday, around 12:30 PM, when Visitor 1 was feeding another resident (Visitor 1's mom), Visitor 1 was standing beside the mom's chair, then Visitor 1 saw a guy (Resident 2) pushing an old lady's (Resident 1) wheelchair, his (Resident 2) hand was on the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056127 If continuation sheet Page 4 of 6 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 056127 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Live Oak Rehab Center 537 W Live Oak San Gabriel, CA 91776 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few lady's (Resident 1) shoulder and then slid down the breast. Visitor 1's written witness statement also indicated, then the lady (Resident 1) was pushing away the guy's (Resident 2) hand. During a concurrent observation and interview with the ADM on 10/8/2025 at 1:40 PM, the facility's video surveillance dated 10/7/2025, timed between 12:15 PM and 12:20 PM was reviewed. Video surveillance showed a recording of Resident 2 standing in the hallway where Resident 1 was passing by while the resident is in her wheelchair. The video surveillance showed Resident 2 started to walk behind and started pushing Resident 1's wheelchair. The video surveillance showed Resident 2 caressed Resident 1's right breast at 12:17:00 PM, and at 12:17:03 PM, Resident 1 was observed pushing off Resident 2's right hand away from Resident 1's right breast. The video surveillance also showed Resident 2 was caressed Resident 1's left breast at 12:17:07 PM, and at 12:17:08 PM, Resident 1 was observed pushing off Resident 1's left hand away from Resident 1's left breast. The ADM verified, the female resident in the wheelchair in the video surveillance is Resident 1, and the male resident behind the wheelchair and pushing Resident 1's wheelchair was Resident 2. The ADM also verified that the family member seen in the video surveillance from 12:17:07 to 12:17:08 was Visitor 1 who witnessed the incident between Resident 1 and 2 and reported the incident to CNA 1. During a concurrent observation in Resident 1's room and an attempt for an interview with Resident 1 on 10/8/2025 at 1:59 PM, Resident 1 was nonverbal. When approached and asked about the incident, Resident 1 could not answer and the resident with a flat affect (a reduced or absent display of emotions in a person's facial expressions, tone of voice, and body language. It is a symptom that can be associated with various mental health conditions). During an attempt for an interview with Resident 2 on 10/8/2025 at 2:02 PM, Resident 2 did not answer the question when asked about the incident on 10/7/2025 with Resident 1. During an interview on 10/8/2025 at 2:37 PM with SSD, SSD stated, yesterday (10/7/2025), the ADM informed SSD that CNA 1 stated Visitor 1 witnessed Resident 1's right breast was touched in circular motion by Resident 2. During an interview on 10/8/2025 at 3:15 PM with LVN 1, LVN 1 stated, on 10/7/2025 (unable to recall time), CNA 1 reported to LVN 1 that Resident 1 was touched on the resident's breast by Resident 2, and Resident 1 pushed it off. During a concurrent record review and interview with the DON on 10/8/2025 at 4:30 PM, facility's video surveillance dated 10/7/2025, timed between 12:15 PM and 12:20 PM was reviewed. The DON stated the video surveillance showed that Resident 1 pushed away Resident 2's hand when Resident 2 touched or massaged Resident 1's right and left breast. The DON stated, this showed Resident 1 was not comfortable or does not want Resident 2 touching or massaging Resident 1's breasts. During an interview with Visitor 1 on 10/9/2025 at 12:40 PM, Visitor 1 stated, on 10/7/2025 at approximately 12:30 PM, Visitor 1 witnessed a female (Resident 1) resident's chest area was being touched by a male resident (Resident 2). Visitor 1 stated she witnessed the female resident (Resident 1) removed the male resident's (Resident 2) hand from the female resident's chest, and Visitor 1 added So, I think she (Resident 1) did not like it. Visitor 1 also stated it is not normal and appropriate for a male resident to touch a female's chest area that is why Visitor 1 reported what she witnessed to CNA 1. During a concurrent record review and interview with MDSN on 10/9/2025 at 1:25 PM, facility's video surveillance dated 10/7/2025, timed between 12:15 PM and 12:20 PM was reviewed. MDSN stated Resident 2's action of pushing Resident 1's wheelchair and touching and squeezing Resident 1's breasts several times was not appropriate and normal. MDSN stated according to the video, Resident 2 was observed squeezing and trying to feel Resident 1's private area (part of the body that is usually covered by clothing) which was Resident 1's breast. MDSN stated this behavior is considered sexual abuse by Resident 2 to Resident 1 and can cause psychosocial effects on Resident 1. During a concurrent observation and interview with the DON on 10/10/2025 at 4:39 PM, the facility's video (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056127 If continuation sheet Page 5 of 6 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 056127 B. Wing A. Building (X3) DATE SURVEY COMPLETED 10/10/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Live Oak Rehab Center 537 W Live Oak San Gabriel, CA 91776 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 0600 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete surveillance dated 10/7/2025, timed between 12:15 PM and 12:20 PM was reviewed. The DON stated according to the video surveillance, Resident 2 was observed caressing Resident 1's breast two times. The DON stated this incident is not acceptable, because there is dignity issue and invasion of privacy. The DON stated this incident is an abuse and can cause decline with Resident 1's wellbeing and can affect Resident 1's mood. During a review of the facility's Policy and Procedure (P&P) titled Resident Rights, revised in February 2021, the P&P indicated Federal and State laws guarantee certain basic rights to all residents of the facility and these rights include the resident's right to be treated with respect, kindness and dignity. The P&P also indicated, resident has the right to be free from abuse. During a review of the facility's P&P titled Abuse, Neglect, Exploitation (taking advantage of a resident for personal gain) and Misappropriation Prevention Program, revised in April 2021, the P&P indicated Residents have the right to be free from abuse, neglect, misappropriation of resident property and exploitation. The P&P also indicated, this includes but is not limited to freedom from corporal punishment (which is physical punishment, is used as a means to correct or control behavior, includes, but is not limited to, pinching, spanking, slapping of hands, flicking, or hitting with an object), involuntary seclusion (separation of a resident from other residents or from her/his room or confinement to her/his room against the resident's will, or the will of the resident representative), verbal, mental, and sexual or physical abuse. Event ID: Facility ID: 056127 If continuation sheet Page 6 of 6