Health inspection·December 22, 2025

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete cared for Resident 1 (on 12/17/2025), Resident 1 had loose stools. During an interview on 12/19/2025 at 3:41 p.m., family member of Resident 1 (FM) 1 stated Resident 1 had been complaining to FM 1 about having diarrhea causing her skin to burn. FM 1 stated she was worried that Resident 1 would get worsening skin breakdown due to the constant moisture from the diarrhea. During an interview on 12/22/2025 at 9:20 a.m., Resident 1 stated she still had diarrhea. During an interview on 12/22/2025 at 1:03 p.m., CNA 3 stated she was caring for Resident 1 that day and Resident 1 had loose stools, CNA 3 stated Resident 1 had had two loose stools that morning. CNA 3 stated and she informed the charge nurses (unknown LVN) about the loose stools. CNA 3 stated Resident 1 had redness (indication of skin irritation) on the peri area (most commonly refers to the perineum, the space between the anus and genitals), possibly from the loose stools and CNA 3 stated Resident 1 sometimes complained of some discomfort and burning from the loose stool touching her skin. During an interview on 12/22/2025 at 1:24 p.m., LVN 4 stated he was caring for Resident 1 for the day, and CNA 3 did not inform him Resident 1 was having loose stools and he gave Resident 1 all her medications including the docusate sodium. LVN 4 stated if he was aware Resident 1 was having loose stool he would have held the docusate sodium and if it was more than one loose stool, he would have made a change of condition (COC) report. During an interview and concurrent record review on 12/22/2025 at 3:15 p.m., the Director of Nursing (DON) stated the CNA's notify the nurses assigned to pass medications (LVNs) when patients are having loose stools. The DON stated the LVN would not know the resident was having loose stool unless the CNA informed them. The DON stated stool softeners and laxatives should be held if a resident was having loose/ watery stools. The DON reviewed Resident 1's Survey Report for bowel movements for the month of 12/2025 and confirmed Resident 1 had multiple episodes of loose watery stool. The DON reviewed Resident 1's MAR for the month of 12/2025 and confirmed Resident 1 was receiving docusate sodium and senna including the days she was experiencing loose/ watery stools. The DON stated docusate sodium and senna should not have been given on the days Resident 1 was having loose/ watery stool because the physician's order stated to HOLD for loose watery stools. The DON stated the potential outcome of giving senna and docusate sodium when a resident was having loose/ watery stools was the risk for skin breakdown, dehydration, and emotional distress. During a review of the facility's Job Description titled: Certified Nursing Assistant undated indicated the CNAs were to report all changes of condition (COC) to the Nurse supervisor or Charge Nurse as soon as practical and to record all entries on the flow sheets (tasks) for bowel and bladder. During a review of the facility's Job Description: Licensed Vocational Nurse undated indicated the LVN was to administer medications as prescribed by the healthcare provider. Event ID: Facility ID: 056166 If continuation sheet Page 2 of 4 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 12/22/2025 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 0760 Ensure that residents are free from significant medication errors. 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 one out of three sampled residents (Resident 1) did not receive Docusate Sodium (a stool softener) and Senna (a laxative medication [softens stool or stimulates the bowels to contract] used to treat constipation [bowel movements are infrequent, hard, or difficult to pass]) while Resident 1 was experiencing diarrhea (loose watery stools).This deficient practice placed Resident 1 at risk for emotional distress, burning and irritation of the skin, worsening moisture associated skin break down (MASD, umbrella term for skin inflammation and breakdown from prolonged exposure to moisture), and dehydration (the body loses more fluids than it is taking in).Findings: During a review of Resident 1's admission Record, the admission Record indicated Resident 1 was admitted to the facility 9/17/2025 and readmitted on [DATE] with diagnoses of dependence on renal dialysis (a person's kidneys have failed [End-Stage Renal Disease or ESRD] and they rely on this life-sustaining treatment to filter waste and fluid from their blood), generalized anxiety disorder (a mental health condition marked by persistent, excessive, and uncontrollable worry about everyday things), depression (a mood disorder that causes a persistent feeling of sadness and loss of interest), and (a person has a surgically created opening [stoma] in their neck leading to the windpipe [trachea] for breathing). During a review of Resident 1's minimum data set (MDS, a resident assessment tool), the MDS indicated Resident 1 was cognitively intact (having sufficient mental function for daily life, demonstrating good judgment, planning, and self-control, without significant impairment) and was at risk for developing pressure injuries (damaged skin and tissue) and had MASD. During a review of Resident 1's Order Summary Report dated 12/2025, the Order Summary Report indicated an order dated 12/11/2025 for docusate sodium oral tablet 100 milligrams (mg, a unit of measurement ) give one tablet twice a day via gastrostomy tube (g-tube, a feeding tube inserted through the abdomen directly into the stomach, providing essential nutrition, fluids, and medicine for those who can't eat or drink enough by mouth) twice a day for bowel management HOLD for loose stools and senna oral tablet 8.6 mg give one tablet via g-tube at bedtime for bowel management HOLD for loose stools. During a review of Resident 1's Medication Administration Report (MAR) for 12/2025, the MAR indicated Resident 1 received docusate sodium oral tablet 100 mg, twice a day between 12/11/2025 and 12/22/2025 (on 12/22/2025, only the 9 a.m. dose had been given at the time of review). The MAR indicated Resident 1 received senna oral tablet 8.6 mg was given every bedtime between 12/11/2025 and 12/21/2025 (except on 12/16/2025, when the medication was refused). During a review of Resident 1's activities of daily living document titled, Document Survey Report dated 12/2025, the Documentation Survey Report for bowel movements indicated Resident 1 had loose/ watery stools on 12/10/2025, 12/11/2025, 12/13/2025, 12/15/2025, 12/18/2025, 12/19/2025, 12/20/2025, 12/21/2025, and 12/22/2025. During an interview on 12/19/2025 at 3:10 p.m., certified nursing assistant (CNA) 3 stated the last time she cared for Resident 1 (on 12/17/2025), Resident 1 was having loose stools. During an interview on 12/19/2025 at 3:41 p.m., family member of Resident 1 (FM) 1 stated Resident 1 had been complaining to FM 1 about having diarrhea causing her skin to burn. FM 1 stated she was worried that Resident 1 would get worsening skin breakdown. During an interview on 12/22/2025 at 9:20 a.m., Resident 1 stated she still had diarrhea. During an interview on 12/22/2025 at 1:03 p.m., CNA 3 stated she was caring for Resident 1 that day and Resident 1 had loose stools, CNA 3 stated Resident 1 had had two loose stools that morning. CNA 3 stated and she informed the charge nurses (unknown LVN) about the loose stools. CNA 3 stated Resident 1 had redness (indication of skin irritation) on the peri area (most commonly refers to the perineum, the space between the anus and genitals), possibly from the loose stools and CNA 3 stated Resident 1 Residents Affected - Some (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056166 If continuation sheet Page 3 of 4 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 12/22/2025 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 0760 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete sometimes complained of some discomfort and burning from the loose stool touching her skin. During an interview on 12/22/2025 at 1:24 p.m., LVN 4 stated CNA 3 did not inform him Resident 1 was having loose stools that day. LVN 4 stated he gave Resident 1 all her medications including the docusate sodium. LVN 4 stated if he was aware Resident 1 was having loose stool he would have held the docusate sodium and if it was more than one loose stool, he would have made a change of condition (COC) report. During an interview and concurrent record review on 12/22/2025 at 3:15 p.m., with the Director of Nursing (DON), Resident 1's MAR dated 12/2025 and Documented Survey Reports dated 12/2025 was reviewed. The DON stated the CNA's notify the nurses assigned to pass medications (LVNs) when patients are having loose stools. The DON stated the LVN could also pull up the task for bowel movements and check if the resident was having loose stools, but the quickest and most efficient way was for the CNAs to report the loose stools to the medication nurse. The DON stated stool softeners and laxatives should be held if a resident was having loose/ watery stools. The DON reviewed Resident 1's Survey Report for bowel movements for the month of 12/2025 and confirmed Resident 1 had multiple episodes of loose watery stools. The DON reviewed Resident 1's MAR for the month of 12/2025 and confirmed Resident 1 was receiving docusate sodium and senna including on the days she was experiencing loose/ watery stools. The DON stated docusate sodium and senna should not have been given on the days Resident 1 was having loose/ watery stools because the physician's order stated to HOLD for loose watery stools. The DON stated the potential outcome of giving senna and docusate sodium when a resident was having loose/ watery stools was the risk for skin breakdown, dehydration, and emotional distress. A review of the facility procedure and policy (P&P) titled, Administering Medications, Revised April 2019 indicated medications were to be administered safe and as prescribed by the physician. The P&P indicated a medication dosage believed to be inappropriate or excessive for the resident, the person to administer the medication would contact the prescriber to discuss the concerns. Event ID: Facility ID: 056166 If continuation sheet Page 4 of 4