Health inspection·August 8, 2025

F 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some standing, sitting or moving), stroke (a condition that occurs when blood flow to the brain is disrupted) and respiratory failure. The Care Plan interventions indicated providing total ADL care as indicated.During a telephone interview on 8/6/2025 at 12:38 p.m. with Resident 5's Responsible Party 1 (RP 1). RP 1 stated she called the facility on 7/26/2025 (exact time undisclosed) to check on Resident 5's condition. RP 1 stated she was told by an unknown licensed nurse that there were no showers given to the residents that day because there was only one RT in Station 1. RP 1 stated Resident 5 missed her scheduled routine shower and felt the care of Resident 5 was unsatisfactory and incomplete. RP 1 stated she was worried that Resident 5 will acquire rashes on her skin, as Resident 5 only gets showered twice a week in the facility. During a review of the facility's undated Resident Shower Schedule, the Shower Schedule indicated Resident 5 was to receive a shower on 7/26/2025.During a review of Resident 5's Documentation Survey Report Bathing Task dated 7/2025, the report indicated Resident 5 did not receive a shower on 7/26/2025.c. During a review of Resident 10's admission Record (Face sheet), the face sheet indicated Resident 10 was originally admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including respiratory failure, tracheostomy, and generalized muscle weaknesses. During a review of Resident 10's MDS dated [DATE], the MDS indicated Resident 10 had severe cognitive impairment and required two or more person assistance from staff to complete his ADLs. During a review of Resident 10's untitled Care Plan dated 5/22/2025, the Care Plan indicated Resident 10 had an ADL self-care performance deficit related to impaired mobility (difficulty moving around or experiencing limitations in their physical movement). The Care Plan goal indicated all of Resident 10's ADL needs will be met daily. During a review of the facility's undated Resident Shower Schedule, the Shower Schedule indicated Resident 10 was to receive a shower on 7/26/2025.During a review of Resident 5's Documentation Survey Report Bathing Task dated 7/2025, the report indicated Resident 10 did not receive a shower on 7/26/2025.d. During a review of Resident 11's admission Record (Face sheet), the Face Sheet indicated Resident 11 was originally admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including respiratory failure, tracheostomy, and epilepsy (a brain disorder in which a person has repeated seizures [uncontrolled movement]).During a review of Resident 11's MDS dated [DATE], the MDS indicated Resident 11 was unable to make decisions for his care needs and required two or more person assistance from staff to complete his ADLs. During a review of Resident 11's untitled Care Plan dated 10/9/2023 and revised 4/3/2025, the Care Plan indicated Resident 11 had an ADL self-care performance deficit related to respiratory failure and impaired mobility. The Care Plan goal indicated to keep Resident 11 clean, dry and well-groomed, with interventions including assist Resident 11 with ADLs as needed and provide total ADL care as indicated.During a review of the facility's undated Resident Shower Schedule, the Shower Schedule indicated Resident 11 was to receive a shower on 7/26/2025.During a review of Resident 11's Documentation Survey Report Bathing Task dated 7/2025, the report indicated Resident 11 did not receive a shower on 7/26/2025.e. During a review of Resident 12's admission Record (Face sheet), the face sheet indicated Resident 12 was admitted to the facility on [DATE] with diagnoses including respiratory failure with tracheostomy and epilepsy.During a review of Resident 12's MDS dated [DATE], the MDS indicated Resident 12 had severe cognitive impairment and required two or more person assistance from staff to complete his ADLsDuring a review of Resident 12's untitled Care Plan dated 7/18/2023 and revised 2/10/2025, the Care Plan indicated Resident 12 had an ADL self-care performance deficit related to respiratory failure and weakness. The Care Plan indicated Resident 12 had interventions which included assisting Resident 12 with ADLs as needed and providing ADL care as indicated.During a review of the facility's undated Resident Shower Schedule, the Shower Schedule indicated Resident 12 was to receive a (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 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 056166 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meadow Creek Post-Acute 7039 Alondra Blvd Paramount, CA 90723 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some shower on 7/26/2025.During a review of Resident 12's Documentation Survey Report Bathing Task dated 7/2025, the report indicated Resident 5 did not receive a shower on 7/26/2025.f. During a review of Resident 13's admission Record (Face sheet), the face sheet indicated Resident 13 was originally admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including respiratory failure, tracheostomy, and intracerebral hemorrhage (a condition where there is bleeding between the skull and the brain tissue).During a review of Resident 13's MDS dated [DATE], the MDS indicated Resident 13 was unable to make decisions for his care needs and required two or more person assistance from staff to complete his ADLs.During a review of Resident 13's untitled Care Plan dated 5/3/2025 and revised 8/8/2025, the Care Plan indicated Resident 13 had an ADL self-care performance deficit related to limited mobility and stroke ([cerebrovascular accident (CVA)] loss of blood flow to part of the brain. The Care Plan interventions indicated Resident 13 needs assistance with bathing. During a review of the facility's undated Resident Shower Schedule, the Shower Schedule indicated Resident 13 was to receive a shower on 7/26/2025.During a review of Resident 13's Documentation Survey Report Bathing Task dated 7/2025, the report indicated Resident 13 did not receive a shower on 7/26/2025.g. During a review of Resident 14's admission Record (Face sheet), the Face Sheet indicated Resident 14 was admitted to the facility on [DATE] with diagnoses including respiratory failure, tracheostomy, dependency on a ventilator, and cerebral infarction.During a review of Resident 14's MDS dated [DATE], the MDS indicated Resident 14 had severe cognitive impairment and required two or more person assistance from staff to complete her ADLs. During a review of Resident 14's untitled Care Plan dated 2/14/2025, the Care Plan indicated Resident 14 had an ADL self-care performance deficit related to cognitive impairment (a condition when a person has problems remembering things, concentrating, making decisions and solving problems). The Care Plan goal indicated to provide assistance to Resident 14 with her ADLs daily. During a review of the facility's undated Resident Shower Schedule, the Shower Schedule indicated Resident 14 was to receive a shower on 7/26/2025.During a review of Resident 14's Documentation Survey Report Bathing Task dated 7/2025, the report indicated Resident 14 did not receive a shower on 7/26/2025.h. During a review of Resident 15's admission Record (Face sheet), the Face Sheet indicated Resident 15 was originally admitted to the facility on [DATE] and readmitted on [DATE], with diagnoses including respiratory failure, tracheostomy, dependency on a ventilator, and cerebral palsy (a group of disorders that affect movement and muscle control due to damage to the developing brain). During a review of Resident 15's MDS dated [DATE], the MDS indicated Resident 15 had severe cognitive impairment and required two or more person assistance from staff to complete his activities of daily living (ADLs) such as bathing, dressing, personal hygiene and toileting a person performs daily care for themselves.During a review of the facility's undated Resident Shower Schedule, the Shower Schedule indicated Resident 15 was to receive a shower on 7/26/2025.During a review of Resident 15's Documentation Survey Report Bathing Task dated 7/2025, the report indicated Resident 15 did not receive a shower on 7/26/2025.i. During a review of Resident 16's admission Record (Face sheet), the face sheet indicated Resident 16 was admitted to the facility on [DATE] with diagnosis including respiratory failure, tracheostomy, dependency on a ventilator and metabolic encephalopathy (a change in how the brain brains works due to underlying condition with symptoms such as confusion, memory loss, difficulty concentrating and changes in personality).During a review of Resident 16's MDS dated [DATE], the MDS indicated Resident 16 had severe cognitive impairment and required two or more person assistance from staff to complete his activities of ADLs.During a review of Resident 16's untitled Care Plan dated 7/11/2025, the Care Plan indicated Resident 16 had an ADL self-care performance deficit related to dementia (a progressive state of decline in mental abilities). The Care (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 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 056166 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meadow Creek Post-Acute 7039 Alondra Blvd Paramount, CA 90723 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Plan goal indicated to provide ADL care to Resident 16 daily. During a review of the facility's undated Resident Shower Schedule, the Shower Schedule indicated Resident 16 was to receive a shower on 7/26/2025.During a review of Resident 16's Documentation Survey Report Bathing Task dated 7/2025, the report indicated Resident 16 did not receive a shower on 7/26/2025.j. During a review of Resident 17's admission Record (Face Sheet), the Face Sheet indicated Resident 17 was originally admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including respiratory failure, tracheostomy, and cerebrovascular disease.During a review of Resident 17's MDS dated [DATE], the MDS indicated Resident 17 had severe cognitive impairment and required two or more person assistance from staff to complete her ADLs.During a record review of the facility's resident census on 7/26/2025, the facility census indicated there were 43 residents located in Station 1.During a record review of the facility's Respiratory Therapist (RT) July 2025 Schedule dated 7/26/2025, the RT Schedule indicated there were two respiratory therapists scheduled to work 12 hours each in Station 1 from 6:00 a.m. to 6:30 p.m.During a record review of the facility's Staff Time Clock Log dated 7/26/2025, the Staff Time Clock Log indicated there were two RTs who each worked three to four hours overtime, respectively from the previous night on 7/25/2025. The Staff Time Clock Log indicated only one RT continued to work at Station 1 for eight hours on 7/26/2025 from 6 a.m. to 6:30 p.m. shift.During an interview on 8/7/2025 at 12:02 p.m., with the Respiratory Therapist 1 (RT 1), RT 1 stated on 7/26/2025 at 6 a.m. to 6:30 p.m., there were 2 respiratory therapists who stayed over from the night shift to help administer the first round of residents' breathing treatments at Station 1. RT 1 stated he continued to work by himself for the rest of the remaining eight hours at Station 1 and was unable to assist with the resident's scheduled showers. During an interview on 8/7/2025 at 1:08 p.m., with Certified Nursing Assistant 1 (CNA 1), CNA 1 stated when she worked on 7/26/2025 from the 7 a.m. to 3 p.m. shift, CNA 1 stated the residents scheduled for a shower were only provided with bed baths because there was only one RT who worked that day. CNA 1 stated the residents from Station 1 must be accompanied by an RT during their shower to prevent accidental removal of their tracheostomy tube and to make sure the residents are safely connected to the ventilator while the nursing assistants perform the task. CNA 1 stated it was important for the residents to be assisted and provided with their ADLs such as a shower because they need to be cleaned well and they will feel comfortable. CNA 1 stated if there were enough RTs that day, the residents wouldn't have missed their scheduled showers.During an interview and record review on 8/8/2025 at 10 a.m., with Treatment Nurse 2 (TN 2), TN 2 stated and confirmed there were 10 residents who were scheduled to have a shower on 7/26/2025 at Station 1. TN 2 stated Resident 4, Resident 5, Resident 10, Resident 11, Resident 12, Resident 13, Resident 14, Resident 15, Resident 16, and Resident 17 were all dependent on the nursing staff and needed respiratory care assistance when showering. TN 2 stated if there were not enough delegated staff to assist the residents during their ADLs, such as showering, the delivery of care of the residents would be delayed and/or missed.During an interview on 8/8/2025 at 12:17 p.m., with the Director of Staff Development (DSD), the DSD stated one of the nursing assistants who worked at Station 1 on 7/26/20205 at 7 a.m. to 3 p.m. shift informed her that the 10 residents who were scheduled to have a shower on that day were given a bed baths because there was not enough respiratory therapists to assist them with the task. The DSD stated it was necessary for the nursing assistant and the respiratory therapist to work hand in hand while providing a shower for the residents located at Station 1. The DSD stated the RT must assist the CNAs to make sure the residents tracheostomy site remains patent and free from accidental dislodgement that could lead to harm and/or death.During an interview on 8/8/2025 at 3:34 p.m., with the Director of Nursing (DON), the DON stated it was important for the facility to be (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 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 056166 B. Wing A. Building (X3) DATE SURVEY COMPLETED 08/08/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Meadow Creek Post-Acute 7039 Alondra Blvd Paramount, CA 90723 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 0677 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete adequately staffed with respiratory therapists in Station 1 during the morning shift so the nursing staff and the RTs can assist the residents during their shower to ensure the residents needs are met and they are monitored for any changes in condition and prevent complications of skin integrity such as rashes and other skin problems. During an interview on 8/82025 at 3:55 p.m., with the [NAME] President and Regional Director (VPRD), the VPRD stated it was the facility staff's responsibility to ensure all residents are assisted with their ADLs such as a shower so the residents feel clean, comfortable and dignified.During a review of the Facility Assessment, revised 2/14/2025, the Facility Assessment indicated the following:a. the facility offers services and care based on the residents' needs including, but not limited to activities of daily living, mobility and fall/injury prevention, bowel and bladder, skin integrity, mental health and behavior, medications, pain management, infection control and prevention, management of medical conditions, special care needs such as subacute and dialysis, nutrition, person-centered psycho/social/spiritual/social support and therapy services such as respiratory therapy.b. the facility provides resources needed to provide competent support and care for the resident population every day and during emergencies by ensuring there is adequate staff including but not limited to nursing services and therapy services such as respiratory therapists, andc. the facility shall ensure there is sufficient staff to meet the needs of the residents at any given time by the licensed nurses and other services such as respiratory therapists to assist the residents and ensure ADLs are completed and the residents' changing needs are provided.During a review of the facility's Policy and Procedure (P&P) titled, Activities of Daily Living (ADL), Supporting, revised 3/2018, the P&P indicated the facility shall be provided with care, treatment and services appropriate to maintain or improve their ability to carry out activities of daily living (ADLs). The P&P indicated the residents who are unable to carry out activities of daily living independently will receive the services necessary to maintain good nutrition, grooming and personal and oral hygiene. Event ID: Facility ID: 056166 If continuation sheet Page 5 of 5