Health inspection·December 9, 2025

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few proposed effective date, the destination, information on the right to appeal, and contact information for the Ombudsman Program and other advocacy agencies), dated 9/7/2025, the NTD indicated Resident 1 was transferred to GACH 1 for elevated temperature and vomiting. The NTD indicated the Departments name, address, telephone and fax number if the resident or RR believes the proposed transfer/discharge was inappropriate and the resident or the RR can file an appeal in writing or by calling the number indicated in the form. The NTD also indicated the state long term care ombudsman's address, telephone and fax number to discuss the proposed transfer and discharge. The NTD did not indicate RR 1's signature.During an interview on 9/30/2025 with RR 1, RR 1 stated she (RR 1) did not receive Resident 1's NTD.During a concurrent interview and record review on 9/30/2025 at 9:46 a.m. with the Assistant Director of Nursing (ADON), Resident 1's NTD, dated 9/7/2025, was reviewed. The ADON stated Registered Nurse (RN) 1 signed the NTD and the NTD should be signed by either Resident 1 or RR 1. The ADON stated staff are not supposed to sign for the resident or the RR.b. During a review of Resident 2's admission Record, the admission Record indicated the facility admitted Resident 2 on 8/12/2025, with diagnoses that included secondary malignant neoplasm of other digestive organs (cancer cells [body's normal cells become abnormal, grow out of control, and don't die when they should, forming a mass called a tumor] from a primary cancer [the original site] have spread to the digestive organs, but the affected digestive organs are not where the cancer first started), urinary tract infection (UTI - an infection in the bladder/urinary tract) and difficulty in walking. The admission Record indicated Resident 2 was discharged on 9/4/2025. The admission Record indicated RR 2 as the first emergency contact person.During a review of Resident 2's H&P, dated 8/13/2025, 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's cognitive skills for daily decisions were intact.During a review of Resident 2's Change of Condition (COC - a document used to record and report any significant changes in a resident's physical, mental, or psychosocial status), dated 9/4/2025, the COC indicated Resident 2 had infected surgical incision (germs, typically bacteria, have caused an infection within the wound after surgery).During a review of Resident 2's NTD, dated 9/4/2025, the NTD indicated Resident 2's RR was notified of Resident 2's transfer to GACH 1 emergency room due to infected surgical incision. The NTD indicated Resident 2 last name.During an interview on 9/30/2025 at 9:30 a.m. with the Social Service Director (SSD), the SSD stated if residents are transferred to GACH the nurses are responsible for completing the NTD. The SSD stated if residents are discharged to other facility except to GACH, the SS are responsible for completing the NTD, attached a copy to the discharge packet and faxed a copy to the Ombudsman. The SSD stated nurses attached the NTD to the transfer packet when residents are transferred to GACH.During a concurrent interview and record review on 9/30/2025 at 9:46 a.m. with the ADON, Resident 2's Notification of Bed Hold, dated 8/12/2025, and NTD, dated 9/4/2025, were reviewed. The ADON stated the Notification of Bed Hold, dated 8/12/2025, indicated Resident 2's signature. The ADON stated Resident 2's NTD, dated 9/4/2025, had a different handwriting and signature. The ADON stated the NTD should be signed by either Resident 2 or RR 2. The ADON stated RN 2 signed Resident 2's NTD and staff are not supposed to sign for the resident or the RR.During an interview on 9/30/2025 at 10:12 a.m. with RN 3, RN 3 stated when a resident is transferred to GACH, the RN completes the NTD, attach a copy to the transfer packet to be given to the transporter who would pick up the resident and fax a copy of the NTD to the Ombudsman. RN 3 stated she (RN 3) was trained by Director of Nursing (DON) 2 (DON 2 - previous DON) to sign the NTD after notifying the resident or RR of the reason of transfer or discharge. RN 2 stated they (RN's) do not mail a copy to RR if residents did not sign or RR were not around during the transfer.During an interview on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056129 If continuation sheet Page 2 of 7 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 056129 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Burbank Healthcare & Rehab 1041 S. Main St. Burbank, CA 91506 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 - Few FORM CMS-2567 (02/99) Previous Versions Obsolete 9/30/2025 at 10:27 a.m. with the SSD, the SSD stated the NTD should be signed by the resident or the RR. The SSD stated if residents or RRs did not sign, the facility should mail a copy.During an interview on 9/30/2025 at 10:39 a.m. with DON 1 (DON 1 - the current DON), DON 1 stated if residents cannot sign and RR was not present during the transfer, the NTD should be mailed the next day to the RR address. DON 1 stated there was no documented evidence that RR was informed of the NTD and their right to appeal for the transfer and discharge. DON 1 stated there was no documented evidence that RR was informed of the Ombudsman and Department information on how and where to file appeal. DON 1 stated Resident 2 and 3's NTD should have been mailed the following day after the transfer.During a concurrent interview and record review on 9/30/2025 at 11:26 a.m. with DON 1, the facility's policy and procedure (P&P) titled, Transfer or Discharge, Facility Initiated, dated 10/2022 and last reviewed on 8/15/2025, the P&P indicated, Once admitted to the facility, residents have the right to remain in the facility. Facility-initiated transfers and discharges, when necessary, must meet specific criteria and require resident/representative notification and orientation, and documentation as specified in this policy.4. Notice of Transfer is provided to the resident and resident representative as soon as practicable before the transfer and to the long-term care (LTC) ombudsman when practicable.5. Notice of Facility Bed-Hold and Return policies are provided to the resident and representatives within 24 hours of emergency transfer.6. Notices are provided in a form and manner that the resident can understand, taking into account the resident's educational level, language, communication barriers, and physical or mental impairments.Notice of Discharge after Transfer.4. Notice to the Office of the State LTC Ombudsman will occur at the same time the notice of discharge is provided to the resident and resident representative.Documentation of Facility-Initiated Transfer or Discharge1. When a resident is transferred or discharged from the facility, the following information is documented in the medical record: .b. That an appropriate notice was provided to the resident and/or legal representative; DON 1 stated the NTD was not mailed to Resident 1 and 2's representatives. DON 1 stated the importance of providing a copy of the NTD was for the representative to know how to appeal the transfer or discharge and what number to call to file an appeal. DON 1 stated it is the representative right to file an appeal. DON 1 stated the facility failed to provide a copy of the NTD to Residents 1 and 2's representatives. DON 1 stated Resident 1 and 2's representatives would not be able to know their rights on how to file an appeal.During an interview on 9/30/2025 at 11:38 a.m. with the Administrator (ADM), the ADM stated Resident 1 and 2's NTD should have been mailed to the representatives. The ADM stated the facility's P&P was not followed. The ADM stated the Social Services were responsible for mailing the NTD. Event ID: Facility ID: 056129 If continuation sheet Page 3 of 7 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 056129 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Burbank Healthcare & Rehab 1041 S. Main St. Burbank, CA 91506 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 0684 Provide appropriate treatment and care according to orders, resident’s preferences and goals. 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 ensure the residents received care consistent with professional standards of practice for one of three sampled residents (Resident 1) by failing to notify the physician on 9/1/2025, when Resident 1 had a 20 millimeter of mercury (mmHg - unit of pressure commonly used for blood pressure readings) decrease in systolic blood pressure (sbp - top number of the blood pressure that represents the pressure in your arteries when your heart pumps blood out to the rest of your body).This failure had the potential to place Resident 1 at risk of orthostatic hypotension (a condition where blood pressure drops significantly when a person stands up from a lying or sitting position) and could negatively impact residents' well-being.Findings: During a review of Resident 1's admission Record, the admission Record indicated the facility admitted Resident 1 on 4/29/2025, with diagnoses that included unspecified (unconfirmed) psychosis (a severe mental condition in which thought, and emotions are so affected that contact is lost with reality), unspecified dementia (a progressive state of decline in mental abilities) and essential hypertension (high blood pressure with no single, identifiable cause).During a review of Resident 1's History and Physical (H&P - a medical examination that involves a doctor taking a patient's medical history, performing a physical exam, and documenting their findings), dated 8/29/2025, 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 8/31/2025, the MDS indicated Resident 1's cognitive (mental action or process of acquiring knowledge and understanding) skills for daily decisions were severely impaired. The MDS indicated Resident 1 needed maximum assistance from staff for showering and toileting. The MDS indicated Resident 1 was on antipsychotic (medication used to help people whose brains are having trouble with reality) medication.During a review of Resident 1's Order Summary Report, dated 8/29/2025, the Order Summary Report indicated to monitor for orthostatic hypotension, call the physician if there is a 20 mmHg drop in sbp or a drop of 10 mmHg in diastolic blood pressure (dbp - bottom number of the blood pressure that measures the pressure your blood is pushing against your artery walls while the heart muscle rests between beats) between two readings (lying position and sitting position) every Wednesday for quetiapine (medication used to help people whose brains are having trouble with reality) use. 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 9/2025, the MAR indicated on 9/1/2025, Resident 1's blood pressure as follows:1. 156/76 mmHg - lying position2. 136/74 mmHg - sitting positionDuring a concurrent interview and record review on 9/30/2025 with Director of Nursing DON) 1, Resident 1's Physician Order, dated 8/29/2025, MAR, and Progress Notes, dated 9/1/2025, were reviewed. DON 1 stated Resident 1's sbp on 9/1/2025, had a 20 mmHg drop from lying to sitting position. DON 1 stated there was no documentation on 9/1/2025, that physician was notified of the 20 mmHg drop. DON 1 stated Licensed Vocational Nurse (LVN) 1 did not follow the physician order and did not notify the physician of the 20 mmHg drop in sbp. DON 1 stated LVN 1 should have called the physician and monitor Resident 1 for signs of hypotension (low blood pressure). DON 1 stated Resident 1's blood pressure could continue to drop and can lead to further complication like syncope (a brief loss of consciousness caused by a temporary decrease in blood flow to the brain). DON 1 stated the facility's policy was to follow physician order.During a review of facility's policy and procedure (P&P) titled, Change in a Resident's Condition or Status, dated 3/2023 and last reviewed on 8/15/2025, the P&P indicated, Our facility promptly notifies the resident, his or her attending physician, and the resident representative of changes in the resident's Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056129 If continuation sheet Page 4 of 7 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 056129 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Burbank Healthcare & Rehab 1041 S. Main St. Burbank, CA 91506 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 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete medical/mental condition and/or status.1. The nurse will notify the resident's attending physician or physician on call when there has been a(an):a. accident or incident involving the resident;b. discovery of injuries of an unknown source;c. adverse reaction to medication;d. significant change in the resident's physical/emotional/mental condition;e. need to alter the resident's medical treatment significantly;f. refusal of treatment or medications two (2) or more consecutive times);g. need to transfer the resident to a hospital/treatment center;h. discharge without proper medical authority; and/[NAME]. specific instruction to notify the physician of changes in the resident's condition. Event ID: Facility ID: 056129 If continuation sheet Page 5 of 7 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 056129 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Burbank Healthcare & Rehab 1041 S. Main St. Burbank, CA 91506 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. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure medical records were complete and accurately documented for two of three sampled residents (Residents 1 and 2), when Resident 1 and Resident 2's Inventory Lists, on the Discharge portion, were left blank.This failure had the potential for Resident 1 and Resident 2's personal belongings to be lost.Findings: a. During a review of Resident 1's admission Record, the admission Records indicated the facility admitted Resident 1 on 4/29/2025, with diagnoses that included unspecified (unconfirmed) psychosis (a severe mental condition in which thought, and emotions are so affected that contact is lost with reality), unspecified dementia (a progressive state of decline in mental abilities) and essential hypertension (high blood pressure with no single, identifiable cause).During a review of Resident 1's Inventory List (a detailed and organized list of everything a person owns), dated 8/28/2025, the Inventory List indicated the Discharge portion of the Inventory List was blank.During a review of Resident 1's History and Physical (H&P - a medical examination that involves a doctor taking a resident's medical history, performing a physical exam, and documenting their findings), dated 8/29/2025, 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 8/31/2025, the MDS indicated Resident 1's cognitive (mental action or process of acquiring knowledge and understanding) skills for daily decisions were severely impaired. The MDS indicated Resident 1 needed maximum assistance from staff for showering and toileting.During an interview on 9/30/2025 at 10:12 a.m. with Registered Nurse (RN) 3, RN 3 stated Resident 1 was discharged from the facility on 9/7/2025.b. During a review of Resident 2's admission Record, the admission Record indicated the facility admitted Resident 2 on 8/12/2025, with diagnoses that included secondary malignant neoplasm of other digestive organs (cancer cells [body's normal cells become abnormal, grow out of control, and don't die when they should, forming a mass called a tumor] from a primary cancer [the original site] have spread to the digestive organs, but the affected digestive organs are not where the cancer first started), urinary tract infection (UTI- an infection in the bladder/urinary tract) and difficulty in walking. The admission Record indicated Resident 2 was discharged on 9/4/2025.During a review of Resident 2's Inventory List, dated 8/12/2025, the Inventory List indicated the Discharge portion of the Inventory List was blank.During a review of Resident 2's H&P, dated 8/13/2025, 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's cognitive skills for daily decisions were intact.During a concurrent interview and record review on 9/30/2025 at 10 a.m. with the Medical Records Director (MRD), Residents 1 and 2's Inventory List were reviewed. The MRD stated Residents 1 and 2's Inventory List-at Discharge were left blank. The MRD stated Social Service needs to complete the Inventory List the following day after discharge or transfer. The MRD stated Social Service Department had been audited and still not completing the Inventory List.During an interview on 9/30/2025 at 10:12 a.m. with RN 3, RN 3 stated Resident 2 was discharged from the facility on 9/4/2025. RN 3 stated residents' belongings are packed and kept by Social Services until picked up by family. RN 3 stated there was a potential for resident's belongings to be lost if inventory list was not completed.During an interview on 9/30/2025 at 10:27 a.m. with the Social Service Director (SSD), the SSD stated Certified Nursing Assistants (CNAs) fill up the Inventory List-at Discharge and the Social Services are responsible for checking to make sure the Inventory list was complete the following day of discharge. The SSD stated Medical Records audits the Inventory List, but Social Services was not informed that Inventory List for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056129 If continuation sheet Page 6 of 7 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 056129 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/09/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Burbank Healthcare & Rehab 1041 S. Main St. Burbank, CA 91506 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 Resident 1 and Resident 2 was incomplete.During an interview on 9/30/2025 at 10:39 a.m. with Director of Nursing (DON) 1, DON 1 stated Resident 1 and Resident 2's belongings can get lost if not listed in the Inventory List. DON 1 stated family should be called to pick up resident's belongings.During an interview on 9/30/2025 at 11:20 a.m. with the SSD, the SSD stated Resident 2's belongings were picked up on 9/4/2025 but were not listed and were not signed in the Inventory List.During an interview on 9/30/2025 at 11:38 a.m. with the Administrator (ADM), the ADM stated the Social Service Department failed to check the inventory list after the residents were discharged from the facility. The ADM stated the Social Service Department failed to complete the inventory list for Residents 2 and failed to obtain Resident 2 or Resident 2's representative's signature upon picked up on 9/4/2025. The ADM stated missing belongings can result if inventory list was not complete and not signed.During a review of facility's policy and procedure (P&P) titled, Personal Property, dated 3/2023 and last reviewed on 8/15/2025, the P&P indicated, The resident's personal belongings and clothing are inventoried and documented upon admission and updated as necessary. Event ID: Facility ID: 056129 If continuation sheet Page 7 of 7