Health inspection·October 28, 2025

F 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few that he was responsible for 14 residents during his morning shift (7 am to 3 pm shift). CNA 1 stated that he cannot complete his assignments due to the acuity (level of medical and care needs) of the residents in the sub-acute unit (specialized medical setting for patients who are no longer in need of acute hospital care but still require more intensive skilled nursing and rehabilitation). CNA 1 stated that he has brought his concerns to the Administrator. CNA 1 stated that despite raising these concerns, no changes had been made to address staffing levels, and he continued to have trouble completing all assigned care tasks, including providing scheduled showers and bed baths. CNA 1 stated that the Respiratory Therapist (RT) 1 discovered approximately 20 maggots around Resident 1's tracheostomy site on 10/22/2025 at approximately 7:00 a.m. CNA 1 stated Registered Nurse (RNS) 2 asked him to provide Resident 1 with a shower immediately on 10/22/2025. CNA 1 stated that he was assisted by CNA 2 and RT 4 also was present during Resident 1' s shower as the resident was a ventilator dependent. CNA 1 stated that during the shower, CNA 1 observed two to three additional maggots around the left side of Resident 1's neck. CNA 1 stated that both the outgoing Registered Nurse Supervisor (RNS) 2 and the incoming day shift (RNS) 3 were aware that maggots had been observed on Resident 1 by RT 1 on 10/22/2025. CNA 1 stated that RNS 2 appeared upset upon learning of the situation and instructed staff not to discuss the incident (maggots on Resident 1's tracheostomy site) . CNA 1 stated that RNS 2 expressed that she did not want to report the findings to the necessary entities. CNA 1 stated that Resident 1's scheduled shower days were Mondays and Thursday and should receive a bed bath on other five days of the week. CNA 1 stated that at times, residents were not showered as scheduled due to the number of residents assigned to each CNAs and due to the residents' acuity and workload demands. CNA 1 stated that due to reduced staffing levels or increased resident care needs, some resident showers were delayed or missed. CNA 1 stated that when residents do not receive their scheduled showers or bed baths, it can lead to poor hygiene, skin breakdown, and a risk of infection. CNA 1 stated inadequate hygiene may attract pests, potentially resulting in infestations, such as maggots. During an interview on 10/23/2025 at 12:00 p.m. in the social service office with the License Vocational Nurse (LVN) 1, LVN 1 stated that residents were scheduled to receive showers twice a week and bed baths five days week. LVN 1 stated CNAs were responsible for providing hygiene care, while LVNs and the treatment nurse were responsible for ensuring that care was completed and properly documented. CNAs document skin inspections on Resident Shower Sheets, which were then reviewed and signed by the treatment nurse for validation. LVN 1 stated the importance of hygiene care in preventing skin breakdown, infections, and infestations, including maggots. LVN 1 stated that Respiratory Therapists (RTs) were responsible for providing oral care every shift and as needed. LVN 1 stated that oral care was essential to prevent infections, mouth sores, and bacterial buildup, which can lead to further health complications. LVN 1 stated that on 10/22/2025 she did not assess Resident 1's mouth during her shift due to workload demands and forgot to perform the assessment. During a concurrent observation and interview on 10/23/2025 at 12:35 p.m. with Respiratory Therapist (RT) 2 in the social services office, RT 2 stated oral care must be performed every shift and as needed, as part of comprehensive tracheostomy management. RT 2 stated that proper oral hygiene was critical to prevent the buildup of secretions, bacterial growth, oral infections, and respiratory complications such as ventilator-associated pneumonia ([NAME] a lung infection that can occur when bacteria enter the lungs through a breathing tube). RT 2 stated that inadequate oral care may lead to skin breakdown in the oral cavity and, in severe cases, infestation, including maggots. RT 2 stated that she last assessed Resident 1 at approximately 7:15 a.m. on 10/22/2025 and noted Resident 1 required oral care at that time. RT 2 stated she only performed suctioning and did not complete oral care due to workload demands and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 If continuation sheet Page 2 of 13 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 10/28/2025 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few other assignment responsibilities. During the interview, RT 2 was shown a photograph of Resident 1's oral cavity. RT 2 reviewed the image, RT 2 stated that Resident 1's oral hygiene appeared poor and unacceptable, and acknowledged that such a condition could have contributed to the reported maggot infestation. During a concurrent interview and record review on 10/23/2025 at 12:45 p.m. with Registered Nurse Supervisor (RNS) 1 in social services office, Resident 1's electronic health record (EHR) was reviewed. RNS 1 stated that there was no documentation indicating the presence of maggots or any related concerns. RNS 1 stated that if such a concern (maggots at the tracheostomy site) had existed, it should have been documented using the SBAR (Situation, Background, Assessment, and Recommendation) communication tool, included in the Nursing Progress Notes, and reported to the physician, the resident's family and CDPH RNS 1 stated that proper documentation and timely reporting were critical for ensuring effective communication among care team members, enabling the physician to make informed treatment decisions, keeping the family informed of significant changes, and ensuring regulatory oversight to protect resident safety. RNS 1 stated that failure to document or report such concerns could result in delayed or inadequate care, worsening the wound, increased risk of infection, and potential non-compliance with state and federal regulations.During a concurrent interview and review on 10/23/2025 at 3:35 p.m. with Director of Nursing (DON) in Social Services Office, Resident 1's Order Summary Report dated 10/22/2025 at 10:54 a.m., was reviewed. The Order Summary Report indicated to transfer Resident 1 to GACH for evaluation of wounds on the left side of the neck. The DON stated she was first informed by RNS 3 on 10/22/2025 at approximately 10:00 a.m. that Resident 1 had maggots present around the tracheostomy site and in the wound. The DON stated she assessed the resident but did not observe any maggots at that time. The DON stated she was unaware of the reason for Resident 1's delay in transferring to GACH on 10/22/2025. The DON stated that RNS 3 was responsible for arranging the transfer of Resident 1 to GACH on 10/22/2025 but was not transferred until 10/23/2025. The DON stated that the presence of maggots in a tracheostomy site or wound reflects poor hygiene and a breakdown in infection control practices. The DON stated this can lead to severe complications, including infection, delayed wound healing, tissue necrosis (death of living tissue), and sepsis (a life-threatening medical emergency).During an interview on 10/23/2025 at 4:09 p.m. in the social service office with the Administrator (ADM), the the Administrator (ADM) stated that he became aware of the presence of maggots around Resident 1's tracheostomy site on 10/22/2025 at approximately 8:30 a.m., after receiving a group text message from facility staff. The ADM confirmed that the message indicated maggots were observed around the tracheostomy and wound area. The ADM stated that, upon receiving this information, he did not notify the California Department of Public Health (CDPH) and did not initiate any immediate follow-up actions. The ADM stated that the incident should have been reported to CDPH without delay and that an internal investigation and documentation review should have been initiated to ensure the resident's safety and regulatory compliance. The ADM stated he was unsure why he failed to follow the facility's established reporting protocol. The ADM stated that facility policy requires immediate reporting to CDPH and prompt initiation of an internal investigation in such cases. The ADM recognized that appropriate notifications and follow-up actions should have been completed in accordance with both regulatory requirements and facility policy.During an interview on 10/24/2025 at 11:21 a.m. with RNS 2 in social services office, RNS 2 stated that on 10/22/2025 at approximately 7:00 a.m., she was informed by RT 1 that Resident 1 had maggots present around the tracheostomy site and a pressure injury located on the left lateral side of Resident 1's neck. RNS 2 stated RT 1 reported discovering the maggots on 10/22/2025 while performing routine tracheostomy care and estimated seeing approximately 20 maggots. RNS 2 stated that she immediately assessed (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 If continuation sheet Page 3 of 13 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 10/28/2025 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 0609 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Resident 1 and observed small white objects moving around both the tracheostomy site and the wound area. RNS 2 acknowledged that although she was aware of the presence of maggots, she did not report the incident because she had to leave work. RNS 2 stated that the presence of maggots can lead to infection and pain. During an interview on 10/24/2025 at 11:54 a.m., with RNS 3, RNS 3 stated that she was informed during shift change on 10/22/2025 at approximately 7:30 a.m. by RNS 2 that Resident 1 had maggots were present around Resident 1's tracheostomy site. RNS 2 stated that Respiratory Therapist (RT) 1 had observed white objects moving in the area during tracheostomy care and later confirmed they were maggots. RNS 3 stated that she immediately went to Resident 1's room to inspect the bed area, as the resident was being showered at the time. RNS 3 stated at approximately 8:00 a.m. on 10/22/2025, she notified the Medical Doctor (MD 1), Director of Nursing (DON), and the facility Administrator via a group text message. RNS 3 stated she informed MD 1 that maggots had been found around Resident 1's tracheostomy site. RNS 3 stated she did not document the incident in the resident's electronic health record (EHR), did not complete a Situation, Background, Assessment, and Recommendation (SBAR) form, and did not submit a change of condition report. RNS 3 stated that she informed Resident 1's family member about the hospital transfer but stated that she did not inform her that Resident 1 was being transferred for re-evaluation of her wound and maggots infestation. RNS 3 stated that she was instructed by the DON not to disclose the presence of maggots to the resident's family member. RNS 3 stated that her response to the incident was not consistent with facility policy or nursing standards of practice.During a review of facility's policy and procedure (P&P) titled Resident Rights revised 2/2021, the P&P indicated Resident rights to be free from abuse, neglect.During a review of facility's P&P titled Abuse, Neglect, Exploitation or Misappropriation-Reporting and Investigating, revised 9/2022, the P&P indicated, If resident abuse, neglect, exploitation, misappropriation of resident property or injury of unknown source is suspected, the suspicion must be reported immediately to the administrator and to other officials according to state law. Cross reference F677 Event ID: Facility ID: 056166 If continuation sheet Page 4 of 13 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 10/28/2025 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 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based interview, and record review, the facility failed to ensure that one of three residents (Resident 1), who was a ventilator (a machine used in healthcare to assist or perform breathing for a patient who cannot breathe adequately) dependent received personal hygiene care, including regularly scheduled showers and bed baths, to prevent maggots (a baby fly that looks like a small, white, worm without legs) infestation around tracheostomy and a Stage III pressure injury (a full-thickness skin loss that extends into the subcutaneous tissue [fat layer]) to the left lateral (relating to or situated on the side) side of the resident's neck. The facility failed to: 1. Ensure Resident 1 was provided with regularly scheduled showers and bed baths to promote the resident's cleanliness in accordance with the facility's policy and procedure (P&P) titled, Bath, Shower/Tub, dated 2018, which indicated, The purposes of this procedure are to promote cleanliness, provide comfort to the resident and to observe the condition of the resident's skin. 2. Ensure Resident 1, provided with the sanitary care to prevent the development of maggot infestation around tracheostomy site and a Stage III pressure injury to the left lateral side of the neck. These deficient practices resulted in Resident 1 developing maggots around the tracheostomy and a Stage III pressure injury to the left lateral side of the neck requiring transfer to an acute care hospital (GACH) on 10/23/2025 for further evaluation and treatment. These deficient practices placed Resident 1 at risk of infection, airway obstruction (when something blocks the path for air to get into their lungs, making it hard to breathe) and compromised respiratory status (trouble breathing).Findings: During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including acute respiratory failure ( a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide [odorless gas]), chronic kidney disease (a medical condition in which a person's kidneys cease functioning on a permanent basis ), dependence on renal dialysis (type of treatment that helps your body remove extra fluid and waste products from your blood when the kidneys are not able to), and dysphagia (difficulty swallowing food or liquids). During a review of Resident 1's History and Physical (H& P) dated 5/25/2024, 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]resident assessment tool) dated 9/14/2025, the MDS indicated Resident 1 was dependent (helper does all the effort; resident does none of the effort to complete the activity or the assistance of two or more helpers is required for the resident to complete the activity) for oral hygiene, toileting hygiene, shower/bath, and personal hygiene. During an observation on 10/23/2025 at 10:30 a.m. in Resident 1's room, Resident 1 was observed lying in bed with a tracheostomy (a surgical procedure that creates an opening in the trachea (windpipe) in the front of the neck) and gastrostomy tube ([GT] a soft tube surgically inserted directly into the stomach to administer medication, fluids and nutrition) in place. Resident 1 was non-verbal (they do not use spoken words to communicate) and not responsive to her environment (showing no engagement with staff or her surroundings. Resident 1's oral cavity (mouth) was observed unclean with a thick, yellowish coating noted on the tongue and inner lips, and dried secretions were observed around the corners of the mouth. Resident 1's lips were dry and cracked. During a review of Resident 1's Care Plan titled Respiratory dated 5/22/2025, the Care Plan interventions/tasks approach indicated oral care every shift to include: lips, teeth, tongue, buccal wall (inner lining of the cheek), and pharynx ( cavity behind the nose and mouth). During an interview on 10/23/2025 at 11:00 a.m. with Certified Nurse Assistant (CNA) 1, in the social service office, CNA 1 stated that he was responsible for 14 residents during his morning shift (7 am to 3 pm Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 If continuation sheet Page 5 of 13 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 10/28/2025 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 shift). CNA 1 stated that he cannot complete his assignments due to the acuity (level of medical and care needs) of the residents in the sub-acute unit (specialized medical setting for patients who are no longer in need of acute hospital care but still require more intensive skilled nursing and rehabilitation). CNA 1 stated that he has brought his concerns to the Administrator. CNA 1 stated that despite raising these concerns, no changes had been made to address staffing levels, and he continued to have trouble completing all assigned care tasks, including providing scheduled showers and bed baths. CNA 1 stated that the Respiratory Therapist (RT) 1 discovered approximately 20 maggots around Resident 1's tracheostomy site on 10/22/2025 at approximately 7:00 a.m. CNA 1 stated Registered Nurse (RNS) 2 asked him to provide Resident 1 with a shower immediately on 10/22/2025. CNA 1 stated that he was assisted by CNA 2 and RT 4 also was present during Resident 1' s shower as the resident was a ventilator dependent. CNA 1 stated that during the shower, CNA 1 observed two to three additional maggots around the left side of Resident 1's neck. CNA 1 stated that both the outgoing Registered Nurse Supervisor (RNS) 2 and the incoming day shift (RNS) 3 were aware that maggots had been observed on Resident 1 by RT 1 on 10/22/2025. CNA 1 stated that Resident 1's scheduled shower days were Mondays and Thursday and should receive a bed bath on other five days of the week. CNA 1 stated that at times, residents were not showered as scheduled due to the number of residents assigned to each CNAs and due to the residents' acuity and workload demands. CNA 1 stated that due to reduced staffing levels or increased resident care needs, some resident showers weree delayed or missed. CNA 1 stated that when residents do not receive their scheduled showers or bed baths, it can lead to poor hygiene, skin breakdown, and a risk of infection. CNA 1 stated inadequate hygiene may attract pests, potentially resulting in infestations, such as maggots. During an interview on 10/23/2025 at 12:00 p.m. in the social service office with the License Vocational Nurse (LVN) 1, LVN 1 stated that residents were scheduled to receive showers twice a week and bed baths five days week. LVN 1 stated CNAs were responsible for providing hygiene care, while LVNs and the treatment nurse were responsible for ensuring that care was completed and properly documented. CNAs document skin inspections on Resident Shower Sheets, which were then reviewed and signed by the treatment nurse for validation. LVN 1 stated the importance of hygiene care in preventing skin breakdown, infections, and infestations, including maggots. LVN 1 stated that Respiratory Therapists (RTs) were responsible for providing oral care every shift and as needed. LVN 1 stated that oral care was essential to prevent infections, mouth sores, and bacterial buildup, which can lead to further health complications. LVN 1 stated that on 10/22/2025 she did not assess Resident 1's mouth during her shift due to workload demands and forgot to perform the assessment. During a concurrent interview and record review on 10/23/2025 at 12:24 p.m. with Treatment Nurse (TN) 1 in the Social Services Office, Resident 1's SNF Wound Care Note dated 10/2025 was reviewed. TN 1 stated that Resident 1 initially developed moisture-associated skin damage (MASD-occurs when skin becomes red, sore, or broken due to prolonged exposure to moisture.) on the left lateral side of the neck on 9/3/2025. TN 1 stated that during an assessment on 10/10/2025, TN 1 identified that the wound had deteriorated and was now classified as a Stage 3 pressure injury (a full-thickness skin loss that extends into the subcutaneous tissue (fat layer)). TN 1 stated that the injury was attributed to the resident's tracheostomy ties (secure the tracheostomy tube). TN 1 stated on 10/10/2025, the wound measured 3.0 centimeter (cm-unit of measurement) by 2.0 cmx 0.3 cm. During a concurrent observation and interview on 10/23/2025 at 12:35 p.m. with Respiratory Therapist (RT) 2 in the social services office, RT 2 stated oral care must be performed every shift and as needed, as part of comprehensive tracheostomy management. RT 2 stated that proper oral hygiene was critical to prevent the buildup of secretions, bacterial growth, oral infections, and respiratory (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 If continuation sheet Page 6 of 13 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 10/28/2025 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 complications such as ventilator-associated pneumonia ([NAME] a lung infection that can occur when bacteria enter the lungs through a breathing tube). RT 2 stated that inadequate oral care may lead to skin breakdown in the oral cavity and, in severe cases, infestation, including maggots. RT 2 stated that she last assessed Resident 1 at approximately 7:15 a.m. on 10/22/2025 and noted Resident 1 required oral care at that time. RT 2 stated she only performed suctioning and did not complete oral care due to workload demands and other assignment responsibilities. During the interview, RT 2 was shown a photograph of Resident 1's oral cavity. RT 2 reviewed the image, RT 2 stated that Resident 1's oral hygiene appeared poor and unacceptable, and acknowledged that such a condition could have contributed to the reported maggot infestation. During a concurrent interview and record review on 10/23/2025 at 12:45 p.m. with Registered Nurse Supervisor (RNS) 1 in social services office, Resident 1's electronic health record (EHR) was reviewed. RNS 1 stated that there was no documentation indicating the presence of maggots or any related concerns. RNS 1 stated that if such a concern (maggots at the tracheostomy site) had existed, it should have been documented using the SBAR (Situation, Background, Assessment, and Recommendation) communication tool, included in the Nursing Progress Notes, and reported to the physician, the resident's family. RNS 1 stated that proper documentation and timely reporting were critical for ensuring effective communication among care team members, enabling the physician to make informed treatment decisions, keeping the family informed of significant changes, and ensuring regulatory oversight to protect resident safety. RNS 1 stated that failure to document or report such concerns could result in delayed or inadequate care, worsening the wound, increased risk of infection, and potential non-compliance with state and federal regulations.During a review of Resident 1's Documentation Survey Report titled Oral Care section for 10/2025, the report indicated that oral care was not documented as provided on the following dates and shifts:Day Shift (7 am-3 pm): 10/4/2025, 10/5/2025, 10/10/2025, 10/14/2025, 10/16/2025, 10/19/2025, 10/20/2025, 10/21/2025, and 10/22/2025Evening Shift (3 pm -11 pm) : 10/19/2025 and 10/23/2025Night Shift (11 pm -7 am): 10/2/2025, 10/11/2025, and 10/21/2025 During a telephone interview, on 10/23/2025 at 2:30 p.m., with Resident 1's medical doctor (MD) 1, MD 1 stated that he was informed by Registered Nurse Supervisor (RNS) 3 on 10/22/2025 that Resident 1 had maggots present around her tracheostomy site and within the left side of the neck's pressure injury wound. MD 1 was unable to recall the exact time he was contacted by RNS 3. MD 1 stated based on the information provided by RNS 3, MD 1 ordered that Resident 1 be transferred to general acute care hospital (GACH) on 10/22/2025 for further evaluation and treatment. During a concurrent interview and review on 10/23/2025 at 3:03 p.m., in the social services office with the Director of Staff Development (DSD), Resident 1's Skin Inspection Sheets dated October 2025 were reviewed. The DSD stated that Resident 1 showers were documented as provided on 10/5/2025, 10/12/2025, and 10/22/2025. The DSD stated that Resident 1 did not receive scheduled showers on 10/6/2025, 10/9/2025, 10/13/2025, 10/16/2025, 10/20/2025, and 10/23/2025, which was significant lapse in personal hygiene care. The DSD stated that Resident 1's scheduled shower days were Mondays and Thursdays, with bed baths to be provided on non-shower days. CNAs were responsible for administering both showers and bed baths. The DSD stated that failure to provide regular bathing can lead to skin breakdown, infection, and an increased risk of infection, including maggot infestation, especially in residents with open or compromised skin. The DSD stated that poor hygiene can contribute to resident discomfort and negatively impact dignity. During a concurrent interview and record review on 10/23/2025 at 3:35 p.m. with the Director of Nursing (DON) in social services office, Resident 1's Physician's Order Summary Report dated 10/22/2025 at 10:54 a.m., was reviewed. The Physician's Order Summary Report dated indicated to transfer Resident 1 to GACH for evaluation of wound on the left side of (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 If continuation sheet Page 7 of 13 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 10/28/2025 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 the neck. The DON stated she was first informed by RNS 3 on 10/22/2025 at approximately 10:00 a.m. that Resident 1 had maggots present around the tracheostomy site and in the left side of the neck wound. The DON stated she assessed the resident but did not observe any maggots at that time. The DON stated that she was aware of the maggot concern when the transfer order was written and stated that the omission of this information from the order was inappropriate, as it failed to accurately reflect the resident's condition. The DON stated she did not know why RNS 3 failed to document the presence of maggots and lack of documentation could be perceived as withholding information. The DON stated that, given the nature of the incident, there should have been an incident report, progress notes documenting the change in condition, and an update to the resident's care plan. During an interview on 10/24/2025 at 10:04 p.m., with Certified Nurse Assistant (CNA) 2 in social services office, CNA 2 stated that she assisted CNA 1 with Resident 1's shower on the morning of 10/22/2025. CNA 2 stated that during the shower, she observed at least three maggots on the left side of the resident's chest. CNA 2 stated that due to the high acuity of residents in the sub-acute unit, she is sometimes unable to fully bathe residents, which negatively impacts their hygiene care. CNA 2 stated that inadequate bathing can compromise a resident's dignity and personal comfort. CNA 2 stated that failure to provide consistent hygiene care may violate residents' rights to cleanliness and respectful treatment. CNA 2 stated that missed hygiene care increases the risk of skin breakdown, infection, and other complications, and may contribute to a decline in overall health and quality of care for residents. During an interview on 10/24/2025 at 11:21 a.m. with RNS 2 in social services office, RNS 2 stated that on 10/22/2025 at approximately 7:00 a.m., she was informed by RT 1 that Resident 1 had maggots present around the tracheostomy site and a pressure injury located on the left lateral side of Resident 1's neck. RNS 2 stated RT 1 reported discovering the maggots on 10/22/2025 while performing routine tracheostomy care and estimated seeing approximately 20 maggots. RNS 2 stated that she immediately assessed Resident 1 and observed small white objects moving around both the tracheostomy site and the wound area. RNS 2 acknowledged that although she was aware of the presence of maggots, she did not report the incident because she had to leave work. RNS 2 stated that the presence of maggots can lead to infection and pain. During an interview on 10/24/2025 at 11:54 a.m., with RNS 3, RNS 3 stated that she was informed during shift change on 10/22/2025 at approximately 7:30 a.m. by RNS 2 that Resident 1 had maggots were present around Resident 1's tracheostomy site. RNS 2 stated that Respiratory Therapist (RT) 1 had observed white objects moving in the area during tracheostomy care and later confirmed they were maggots. RNS 3 stated that she immediately went to Resident 1's room to inspect the bed area, as the resident was being showered at the time. RNS 3 stated at approximately 8:00 a.m. on 10/22/2025, she notified the Medical Doctor (MD 1), Director of Nursing (DON), and the facility Administrator via a group text message. RNS 3 stated she informed MD 1 that maggots had been found around Resident 1's tracheostomy site. RNS 3 stated she did not document the incident in the resident's electronic health record (EHR), did not complete a Situation, Background, Assessment, and Recommendation (SBAR) form, and did not submit a change of condition report. RNS 3 stated that she informed Resident 1's daughter about the hospital transfer. During a review of Resident 1's GACH Discharge Summary, the Discharge Summary indicated History of present illness, Resident 1 came from a nursing home, was found to have.neck sore and maggots.During a review of the facility's policy and procedure (P&P) titled, Infection Prevention and Control Program, dated 2018, the P&P indicated, An infection prevention and control program (IPCP) is established and maintained to provide a safe, sanitary and comfortable environment and to help to prevent the development and transmission of communicable diseases and infections. During a review of the facility's policy and procedure (P&P) titled, Bath, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 If continuation sheet Page 8 of 13 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 10/28/2025 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 Shower/Tub, dated 2018, the P&P indicated, The purposes of this procedure are to promote cleanliness, provide comfort to the resident and to observe the condition of the resident's skin. During a review of the facility's policy and procedure (P&P) titled, Tracheostomy: Tube Suctioning with a in-Line Catheter, [undated], the P&P indicated, Purpose: To maintain a clear and patent airway. To protect the resident from cross infection or contamination of the airway. Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 If continuation sheet Page 9 of 13 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 10/28/2025 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 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 maintain complete and accurate clinical records for one of three sampled residents (Resident 1). The facility failed to: 1. Document on Resident 1's Electronic Health Record (EHR-a digital system used to document and manage a resident's health information ) the discovery of maggots around Resident 1's tracheostomy site (a surgically created opening in the neck to assist with breathing) on 10/22/2025.2.Document a change in condition, the SBAR Situation, Background, Assessment, Recommendation (SBAR) communication tool to inform or escalate the issue to appropriate clinical staff.These deficient practices had the potential to compromise the continuity of care, delay necessary medical intervention, and negatively impact the resident's health and safety.Findings: During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including acute respiratory failure ( a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide [odorless gas]), chronic kidney disease (a medical condition in which a person's kidneys cease functioning on a permanent basis ), dependence on renal dialysis (type of treatment that helps your body remove extra fluid and waste products from your blood when the kidneys are not able to), and dysphagia (difficulty swallowing food or liquids). During a review of Resident 1's History and Physical (H& P) dated 5/25/2024, 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]resident assessment tool) dated 9/14/2025, the MDS indicated Resident 1 was dependent (helper does all the effort; resident does none of the effort to complete the activity or the assistance of two or more helpers is required for the resident to complete the activity) for oral hygiene, toileting hygiene, shower/bath, and personal hygiene. During a concurrent interview and record review on 10/23/2025 at 12:45 p.m. with Registered Nurse Supervisor (RNS) 1 in social services office, Resident 1's electronic health record (EHR) was reviewed. RNS 1 stated that there was no documentation indicating the presence of maggots or any related concerns. RNS 1 stated that if such a concern (maggots at the tracheostomy site) had existed, it should have been documented using the SBAR communication tool, included in the Nursing Progress Notes, and reported to the physician, the resident's family. RNS 1 stated that proper documentation and timely reporting were critical for ensuring effective communication among care team members, enabling the physician to make informed treatment decisions, keeping the family informed of significant changes, and ensuring regulatory oversight to protect resident safety. RNS 1 stated that failure to document or report such concerns could result in delayed or inadequate care, worsening the wound, increased risk of infection, and potential non-compliance with state and federal regulations.During a concurrent interview and record review on 10/23/2025 at 3:35 p.m. with the Director of Nursing (DON) in social services office, Resident 1's Physician's Order Summary Report dated 10/22/2025 at 10:54 a.m., was reviewed. The Physician's Order Summary Report dated indicated to transfer Resident 1 to GACH for evaluation of wound on the left side of the neck. The DON stated she was first informed by RNS 3 on 10/22/2025 at approximately 10:00 a.m. that Resident 1 had maggots present around the tracheostomy site and in the left side of the neck wound. The DON stated she assessed the resident but did not observe any maggots at that time. The DON stated that she was aware of the maggot concern when the transfer order was written and stated that the omission of this information from the order was inappropriate, as it failed to accurately reflect the resident's condition. The DON stated she did not know why RNS 3 failed to document the presence of maggots and lack of documentation could be perceived as withholding (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 If continuation sheet Page 10 of 13 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 10/28/2025 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 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete information. The DON stated that, given the nature of the incident, there should have been an incident report, progress notes documenting the change in condition, and an update to the resident's care plan. During an interview on 10/24/2025 at 11:54 a.m., with RNS 3, stated she informed MD 1 that maggots had been found around Resident 1's tracheostomy site. RNS 3 stated she did not document the incident in the resident's electronic health record (EHR), did not complete a SBAR form, and did not submit a change of condition report. RNS 3 stated that she informed Resident 1's family member about the hospital transfer but stated that she did not inform her that Resident 1 was being transferred for re-evaluation of her wound and maggots' infestation. RNS 3 stated that her response to the incident was not consistent with facility policy or nursing standards of practice. During a review of the facility's policy and procedure (P&P) titled, Change in a Resident's Condition or Status, dated 2021, the P&P indicated, The nurse will record in the resident's medical record information relative to changes in the resident's medical/mental condition or status.During a review of the facility's Job Description: Registered Nurse (RN), [undated], the Job Description indicated, Ensures the appropriate and timely documentation of resident care activities.During a review of the facility's policy and procedure (P&P) titled, Accidents and Incidents-Investigating and Reporting, dated 2017, the P&P indicated, The Nurse Supervisor/Charge Nurse and/or the department director or supervisor shall promptly initiated and document investigation of the accident or incident.Cross reference F677 and F609 Event ID: Facility ID: 056166 If continuation sheet Page 11 of 13 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 10/28/2025 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 0880 Provide and implement an infection prevention and control program. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure that staff followed proper infection prevention and control practices while providing tracheostomy care for one of three sampled residents (Resident 3). The facility failed to:1. Ensure staff adhered to infection control protocols during tracheostomy (a surgical procedure that creates an opening in the trachea (windpipe) in the front of the neck) care (procedure involving the routine cleaning and management of a tracheostomy tube and surrounding skin to maintain airway patency and prevent infection).2.Ensure Respiratory therapist (RT) 3 was not wearing artificial (acrylic) nails while providing tracheostomy care to Resident 3 on 10/24/2025.This failure placed ventilator (a machine that delivers oxygen to the lungs to assist with breathing) dependent residents at risk for cross-contamination (the transfer of bacteria, viruses, microorganisms, or other harmful substances from one surface to another through improper or unsanitary equipment, procedures, or products) and infection.Findings:During a review of Resident 3's admission Record, the admission Record indicated Resident 3 was initially admitted to the facility on [DATE] and readmitted on [DATE] with diagnoses including acute respiratory failure ( a condition in which your blood doesn't have enough oxygen or has too much carbon dioxide [odorless gas]), dependence on renal dialysis (type of treatment that helps your body remove extra fluid and waste products from your blood when the kidneys are not able to), ventilator (a machine used in healthcare to assist or perform breathing for a patient who cannot breathe adequately) dependence and tracheostomy (a surgical procedure that creates an opening in the trachea (windpipe) in the front of the neck). During a review of Resident 3's Minimum Data Set ([MDS]resident assessment tool) dated 7/22/2025, the MDS indicated Resident 3 was dependent (helper does all the effort; resident does none of the effort to complete the activity or the assistance of two or more helpers is required for the resident to complete the activity) for oral hygiene, toileting hygiene, shower/bath, and personal hygiene. During an interview on 10/23/2025 at 3:35 p.m. in the social service office with the Director of Nursing (DON), the DON stated that artificial nails were not permitted to be worn by staff in the facility, as they can harbor bacteria and increase the risk of infection transmission. The DON emphasized that poor infection control practices, including failure to provide regular bathing and oral care, combined with contamination risks from artificial nails, can contribute to skin breakdown, infection, and risk for maggots (a baby fly that looks like a small, white, worm without legs) infestations. During an observation on 10/24/2025 at 1:35 p.m. the Respiratory Therapist (RT) 3 was observed in resident room performing tracheostomy care and suctioning to Resident 3. RT 3 was observed wearing acrylic (artificial) nails. During an interview on 10/24/2025 at 1:50 p.m. with the Respiratory Therapist (RT) 3 in the social service office, RT 3 confirmed that she was wearing acrylic (artificial) nails at the time and stated that this was a violation of facility policy, which prohibits staff from wearing artificial nails while providing direct care-particularly for residents in the sub-acute unit-due to the increased risk of harboring bacteria and causing cross-contamination. RT 3 stated that failure to provide proper oral care can lead to bacterial buildup, increase the risk of aspiration pneumonia (lung infection), and cause infection at the tracheostomy site, especially in immunocompromised ( a condition in which a person has a weakened or impaired immune system, making them more vulnerable to infections and illness) residents. RT 3 also stated that poor oral hygiene can contribute to infestation, such as maggots, due to the accumulation of debris and bacteria in the mouth, which may attract flies. RT 3 stated that if not addressed promptly, flies may lay eggs in areas with poor hygiene, leading to infestation. During a concurrent interview and record review on 10/27/2025 at 8:58 a.m. in the social service office with the Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 If continuation sheet Page 12 of 13 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 10/28/2025 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 0880 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Infection Preventionist (IP), the facility's policy and procedure (P&P) titled, Handwashing/Hand Hygiene, dated 8/2019 was reviewed. The IP stated that poor oral hygiene and inadequate personal hygiene can create conditions conducive to bacterial growth and odor, which may attract flies. The IP stated that if flies are drawn to a resident due to poor hygiene, they may lay eggs on the skin or within wound areas, which could subsequently develop into maggots if not promptly identified and treated. The IP stated that he was not aware of any current system in place to ensure that staff are adhering to the artificial nail policy. The IP stated that staff wearing artificial nails pose an infection control risk to the residents, especially those who are severely ill or immunocompromised. The IP stated that artificial fingernails can harbor bacteria, fungi, and other microorganisms even after handwashing, which may increase the risk of cross-contamination and infection transmission during resident care. The IP stated that for residents with open wounds, tracheostomies, or ventilators, exposure to bacteria from contaminated nails could lead to serious infections, delayed wound healing, or sepsis (infection in the blood).During a review of the facility's policy and procedure (P&P) titled, Handwashing/Hand Hygiene, dated 2019, the P&P indicated, Wearing artificial fingernails is strongly discouraged among staff members with direct resident-care responsibilities, and is prohibited among those caring for severely ill or immunocompromised residents. The infection preventionist maintains the right to request the removal of artificial fingernails at any time if he or she determines that they present an unusual infection control risk. Event ID: Facility ID: 056166 If continuation sheet Page 13 of 13