Health inspection·December 3, 2025

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Resident 1's physician. LVN 2 stated he did not report the missed dose of Heparin to RN 2 due to fear of being labeled a snitch. During a telephone interview on 12/1/2025 at 12:23 p.m., LVN 1 stated at approximately 2:45 p.m., he was finishing his charting and Resident 1 had not returned from physical therapy yet, which was why he did not give Resident 1 her dose of Heparin. LVN 1 stated he made a mistake, by not giving Resident 1 her dose of Heparin and not reporting the missed medication to Resident 1's physician. b. During an interview on 12/1/2025 at 1:24 p.m., Resident 1's Responsible Party (RP) stated she contacted Resident 1's physician on 11/11/2025 at 1:57 a.m., about her concerns regarding Resident 1's condition and the ultrasound doppler's (machine that uses sound waves to check how blood flows through the body) timelines. The RP stated Resident 1's physician agreed to send Resident 1 to the GACH prior taking conducting the doppler exam, however Resident 1 preferred to stay at the facility until the ultrasound doppler was completed. During a review of Resident 1's Physician's Order dated 11/11/2025, the Physician's Order indicated a Stat (immediate) venous doppler of Resident 1's left leg to rule out a DVT. During a review of facility's mobile phone text messages dated 11/11/2025 and timed at 2 a.m., the text message indicated Resident 1's physician sent a text message that indicated, Resident 1's RP requested to send Resident 1 to the GACH. During a review of Resident 1's Nursing Note dated 11/11/2025, the Nursing Note indicated the venous doppler could not be performed because a soft leg cast and leg brace were present. During a review of Resident 1's Physician Order dated 11/11/2025, the Physician Order indicated Resident 1 may transfer to the GACH for further evaluation. During an interview on 12/2/2025 at 3:09 p.m., LVN 3 stated he spoke to Resident 1 about the transfer to the GACH and Resident 1 told him she wanted to stay at the facility until the ultrasound doppler was completed. LVN 3 stated he did not call Resident 1's physician to inform him that Resident 1 would not be transferred to the GACH. LVN 3 stated he was waiting to see if the ultrasound doppler would be completed prior to the end of his shift and if not, he would endorse it to the next shift, who could call Resident 1's physician to obtain an order to transfer Resident 1 to the GACH. During a telephone interview on 12/3/2025 at 11:14 a.m., Resident 1's physician stated he was not informed that Resident 1 did not receive a dose of Heparin that was due to be given to her on 11/11/2025, until 11/16/2025, when the Director of Nursing (DON) informed him. Resident 1's physician stated he was not informed about Resident 1's decision not to transfer to the GACH on 11/11/2025, until the next morning (11/12/2025) when Resident 1 was transferred to the GACH after the ultrasound doppler was not completed at the facility on 11/11/2025. During an interview on 12/3/2025 at 1:45 p.m., the Director of Nursing (DON) stated LVN 1 forgot to administer Resident 1's afternoon dose of Heparin because Resident 1 was in physical therapy and it was close to change of shift. The DON stated LVN 1 should have notified Resident 1's physician about the missed dose of Heparin, monitor Resident 1 for any COC, notify the pharmacist, the Registered Nurse Supervisor (RNS), and the DON. The DON stated Resident 1's physician should have been informed when Resident 1 was not transferred to the GACH because additional interventions might have been ordered. During a review of the facility's Job Description for Charge Nurse RN/LVN, the Job Description indicated a specific job function included observing, reporting and recording findings/changes in resident's condition to physician and nursing personnel. During a review of the facility's undated P/P titled Notification of Changes the P/P indicated the facility must consult with the resident's physician when there are circumstances that require a need to alter treatment. During a review of the facility's undated Policy and Procedure (P/P) titled Medication Error Policy the P/P indicated when a medication error is noticed the nurses contacts the provider as needed for direction and documents the communication. The P/P indicated the medication error should be reported within the facility by informing the charge nurse, RN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056188 If continuation sheet Page 2 of 11 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 056188 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Long Beach Care Center, Inc 2615 Grand Avenue Long Beach, CA 90815 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 0580 supervisor, and DON according to the facility's communication process. Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056188 If continuation sheet Page 3 of 11 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 056188 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Long Beach Care Center, Inc 2615 Grand Avenue Long Beach, CA 90815 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure one of four sampled residents (Resident 2) was free from physical abuse when Resident 3 entered Resident 2's room and hit Resident 2 repeatedly with a plastic water pitcher and her fists. This deficient practice resulted in Resident 2 feeling afraid while using his arms in self-defense against Resident 3'a attack on him and sustaining a 1.0 centimeter ([cm]-unit of measurement) x 0.5 cm abrasion (a break in the skin when the skin rubs off) to the right side of his forehead, along with multiple areas of redness to Resident 2's right forehead and right forearm, requiring immediate first aid for seven days.Findings: During a review of Resident 2's admission Record (Face Sheet), the Face Sheet indicated Resident 2 was admitted to the facility on [DATE] with a diagnosis of metabolic encephalopathy (a brain dysfunction caused by a chemical imbalance from an underlying illness). During a review of Resident 2's Minimum Data Set ([MDS] a resident assessment tool) dated 9/23/2025, the MDS indicated Resident 2's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) was intact and Resident 2 was dependent on facility staff for bed mobility and ambulation was not attempted. During a review of Resident 2's Change of Condition (COC) form dated 11/25/2025 and timed at 6:50 a.m., the COC form indicated Resident 3 entered Resident 2's room, went directly to him, took a water pitcher (Resident 2's water pitcher) and struck Resident 2 on his face. The COC form indicated Resident 2 and 3 were immediately separated by removing Resident 3 from Resident 2's room. The COC form indicated Resident 2 sustained an abrasion to his right temporal (side of the forehead) area measuring 1 cm x 0.5 cm and multiple areas of redness to his right forearm. During a review of Resident 2's Skin Integrity Sheet dated 11/25/2025, the Skin Integrity Sheet indicated the following: 1. A right temporal abrasion measuring 1 cm x 0.5 cm draining blood and a pink wound bed 2. Multiple areas of redness to Resident 2's right forehead. 3. Multiple areas of redness to Resident 2's right forearm. During a review of Resident 2's Treatment Administration Record (TAR) date 11/25/2025 through 12/1/2025, the TAR indicated Resident 2's right forehead with multiple areas of redness was cleansed with normal saline (a sterile, saltwater solution used in medicine to clean wounds). dried, and bacitracin ointment applied for 14 days. During a review of Resident 3's admission Record (Face Sheet), the Face Sheet indicated Resident 3 was admitted to the facility on [DATE] with a diagnosis of metabolic encephalopathy (brain dysfunction) and schizophrenia (a mental illness that is characterized by disturbances in thought). During a review of Resident 3's MDS dated [DATE], the MDS indicated Resident 3's cognition was moderately impaired, and Resident 3 required substantial/maximal assistance (helper does more than half the effort) to complete her ADLs. During a review of Resident 3's Nursing Notes dated 11/25/2025 and timed at 6:50 a.m., the Nursing Notes indicated facility staff responded to yelling and screaming and found Resident 3 in Resident 2's room. The Nursing Note indicated Resident 3 took a water pitcher and hit Resident 2 on the right side of his face. The Nursing Note indicated Resident 3 was very aggressive when facility staff assisted her back to her room and she continued to yell and scream in the hallway. The Nursing Notes indicated Resident 3 required one-to-one (the continuous supervision of a single resident by a dedicated staff member whose sole responsibility is to watch that resident) staff monitoring. During an observation and interview on 12/2/2025 at 2:18 p.m., the right side of Resident 2's forehead revealed a small light area of a healed scar. Resident 2 stated on the morning of 11/25/2025, Resident 3 entered his room yelling at him he's the one then proceeded to throw a banana at him, then hit him with a plastic water pitcher. Resident 2 stated it happened so fast, he put his arms up to protect himself and (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056188 If continuation sheet Page 4 of 11 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 056188 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Long Beach Care Center, Inc 2615 Grand Avenue Long Beach, CA 90815 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete even went under the blanket. Resident 2 stated he had never seen Resident 3 prior to her entering his room that morning, it shocked him, and he was scared because he didn't know what Resident 3 was going to do to him. Resident 2 stated he yelled for help, closed his eyes and he could feel repeated blows to his head for 10-15 seconds, then Certified Nursing Assistants (CNA 1 and CNA 2) came and removed Resident 3 from his room. During an interview on 12/2/2025 at 2:48 p.m., Resident 7 (Resident 2's roommate) stated he was in the hallway (11/25/2025) getting coffee when he saw Resident 3 enter Resident 2's room and go straight to Resident 2 saying you're the one and that he raped her (Resident 3). Resident 7 stated he saw Resident 3 swinging her fists and hit Resident 2. During a telephone interview on 12/3/2025 at 8:54 a.m., CNA 1 stated she was taking the linen and trash barrels near the kitchen area (11/25/2025) when she saw someone (Resident 3) rush into Resident 2's room. CNA 1 stated she saw Resident 3 throw water from a water pitcher onto the floor and proceeded to hit Resident 2 with the water pitcher. CNA 1 stated, Resident 3 was screaming and cursing at Resident 2 saying he gave me a shot, and he raped me. CNA 1 stated Resident 3 was very combative when she and CNA 2 removed her from Resident 2's room. During an interview on 12/3/2025 at 9:28 a.m., CNA 2 stated she was passing coffee to Resident 7 outside of Resident 2's room (11/25/2025) when she saw CNA 1 quickly enter Resident 2's room. CNA 2 stated she followed CNA 1 into Resident 2's room and saw Resident 3 grab a water pitcher and hit Resident 2 with it, while Resident 2 was covering himself. During an interview on 12/3/2025 at 1:45 p.m., the Director of Nursing (DON) stated Resident 2 reported to him that Resident 3 entered his room (11/25/2025) saying, he's the one and hit him (Resident 2) with a water pitcher. The DON stated Resident 2 did not know Resident 3 and he (Resident 2) did not know what prompted the incident. During a review of the facility's undated Policy and Procedure (P/P) titled, Abuse, Neglect and Exploitation the P/P indicated residents should not be subject to abuse by anyone including but not limited to facility staff, and other residents. Event ID: Facility ID: 056188 If continuation sheet Page 5 of 11 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 056188 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Long Beach Care Center, Inc 2615 Grand Avenue Long Beach, CA 90815 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 Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to report an allegation of sexual abuse to the California Department of Public Health (CDPH) for one of four sample residents (Resident 3) when Resident 3 was heard by facility staff accusing Resident 1 of raping her. This deficient practice resulted in CDPH being unaware of the allegation of sexual abuse and the inability to investigate the allegation timely. This deficient practice had the potential for information to be lost and/or forgotten and placed Resident 3 at risk for continued abuse. Findings: During a review of Resident 3's admission Record (Face Sheet), the Face Sheet indicated Resident 3 was admitted to the facility on [DATE] with a diagnosis of metabolic encephalopathy (brain dysfunction) and schizophrenia (a mental illness that is characterized by disturbances in thought). During a review of Resident 3's Minimum Data Set ([MDS] a resident assessment tool) dated 9/21/2025, the MDS indicated Resident 3's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) was moderately impaired and Resident 3 required substantial/maximal assistance (helper does more than half the effort) to complete her ADLs. During an interview on 12/2/2025 at 2:48 p.m., Resident 7 stated he saw Resident 3 enter Resident 2's room, go straight to Resident 2 and said, you're the one you raped me . During a telephone interview on 12/3/2025 at 8:54 a.m., Certified Nursing Assistant (CNA) 1 stated she was taking out the linen and trash barrels near the kitchen area when she saw someone (Resident 3) rush into Resident 2's room, she then saw Resident 3 throw water from a pitcher onto the floor, then proceeded to hit Resident 2 with the water pitcher. CNA 1 stated Resident 3 was screaming and cursing at Resident 2 saying he gave me a shot, and he raped me. CNA 1 stated she provided a written report to Registered Nurse (RN 1), but she did not include Resident 3's accusation that Resident 2 raped her because she thought RN 1 would report it since she (RN 1) was nearby when Resident 3 made the allegation. During an interview on 12/3/2025 at 9:43 a.m., RN 1 stated she overheard CNA 1 talking about Resident 3's allegation that Resident 2 raped her and she (RN 1) reported that allegation to the Director of Nursing (DON). During an interview on 12/3/2025 at 1:45 p.m., the DON stated he was aware of Resident 3's allegation that Resident 2 raped her but stated he forgot to include the allegations when he reported the resident to resident incident on the same day between Resident 2 and Resident 3 to CDPH. During an interview on 12/3/2025 at 3:04 pm, the Administrator (ADM) stated he was not aware of the rape allegation made by Resident 3, had he known about the allegation, he would have reported it to CDPH. The ADM stated the allegation should have been reported to CDPH because facility staff were mandated reporters. During a review of the facility's undated Policy and Procedure (P/P) titled Abuse, Neglect and Exploitation the P/P indicated when abuse, neglect, or exploitation is suspected, the Licensed Nurse should contact the State Agency to report the alleged abuse. Event ID: Facility ID: 056188 If continuation sheet Page 6 of 11 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 056188 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Long Beach Care Center, Inc 2615 Grand Avenue Long Beach, CA 90815 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 0610 Respond appropriately to all alleged violations. 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 investigate one of four sampled residents' (Resident 3) allegation of sexual abuse when Resident 3 yelled and screamed at Resident 2 that he (Resident 2) raped her. This deficient practice resulted in the facility's inability to determine if the allegation had actually occurred and had the potential for other uninvestigated allegations of abuse to be uninvestigated. Findings: During a review of Resident 3's admission Record (Face Sheet), the Face Sheet indicated Resident 3 was admitted to the facility on [DATE] with a diagnosis of metabolic encephalopathy (brain dysfunction) and schizophrenia (a mental illness that is characterized by disturbances in thought). During a review of Resident 3's Minimum Data Set ([MDS] a resident assessment tool) dated 9/21/2025, the MDS indicated Resident 3's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) was moderately impaired and Resident 3 required substantial/maximal assistance (helper does more than half the effort) to complete her ADLs. During a review of Resident 3's Nursing Notes dated 11/25/2025 and timed at 6:50 a.m., the Nursing Notes indicated facility staff responded to yelling and screaming and found Resident 3 in Resident 2's room. The Nursing Note indicated Resident 3 took a water pitcher and hit Resident 2 on the right side of his face. The Nursing Note indicated Resident 3 was very aggressive when facility staff assisted her back to her room and she continued to yell and scream in the hallway. The Nursing Notes indicated Resident 3 required one-to-one (the continuous supervision of a single resident by a dedicated staff member whose sole responsibility is to watch that resident) staff monitoring. During an interview on 12/2/2025 at 2:48 p.m., Resident 7 (Resident 2's roommate) stated he was in the hallway (11/25/2025) getting coffee when he saw Resident 3 enter Resident 2's room and go straight to Resident 2 saying you're the one and that he raped her (Resident 3). Resident 7 stated he saw Resident 3 swinging her fists and hit Resident 2. During a telephone interview on 12/3/2025 at 8:54 a.m., CNA 1 stated she was taking the linen and trash barrels near the kitchen area (11/25/2025) when she saw someone (Resident 3) rush into Resident 2's room. CNA 1 stated she saw Resident 3 throw water from a water pitcher onto the floor and proceeded to hit Resident 2 with the water pitcher. CNA 1 stated, Resident 3 was screaming and cursing at Resident 2 saying he gave me a shot, and he raped me. CNA 1 stated Resident 3 was very combative when she and CNA 2 removed her from Resident 2's room. During an interview on 12/3/2025 at 9:43 a.m., RN 1 stated she overheard CNA 1 talking about Resident 3's allegation that Resident 2 raped her and she (RN 1) reported that allegation to the Director of Nursing (DON). During an interview on 12/3/2025 at 1:45 p.m., the DON stated he was aware of Resident 3's allegation that Resident 2 raped her but stated he forgot to include the allegations when he reported the resident to resident incident on the same day between Resident 2 and Resident 3 to CDPH. The DON stated he interviewed Resident 2 and Resident 3 regarding Resident 3's allegation that she was raped by Resident 2, but he was told by 3 to get the Fuck out before, then she was transferred to a General Acute Care Hospital (GACH). The DON stated Resident 2 stated he did not know Resident 3. The DON stated Resident 2 could not get up without assistance, so he concluded the allegation was not true. The DON was not able to provide documentation to indicate he investigated Resident 3's allegation of rape against Resident 2. During a review of the facility's undated Policy and Procedure (P/P), titled Abuse, Neglect and Exploitation, the P/P indicated when suspicion of abuse, neglect or exploitation, or reports of abuse, neglect or exploitation occur, an investigation is immediately warranted. The P/P indicated components of an investigation may include interviewing the involved residents, if possible, and to document all responses. The P/P indicated to document the entire investigation chronologically. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056188 If continuation sheet Page 7 of 11 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 056188 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Long Beach Care Center, Inc 2615 Grand Avenue Long Beach, CA 90815 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 Licensed Vocational Nurse (LVN) 1 administered Heparin (a medication used to prevent the formation of blood clots [masses of blood that form when blood cells stick together]) as ordered by the physician for deep vein thrombosis ([DVT] a blood clot in a vein, usually in the leg) prophylaxis (treatment to prevent disease or infection from occurring or spreading) for one of four sampled residents (Resident 1). This deficient practice contributed to Resident 1 experiencing swelling and heaviness in her left lower extremity (leg), her subsequent transfer to a General Acute Care Hospital (GACH), where she was assessed and diagnosed with an extensive acute deep vein DVT of the left lower extremity.Findings: During a review of Resident 1's admission Record (Face Sheet), the Face Sheet indicated Resident 1 was admitted to the facility on [DATE] with a diagnosis of a displaced intertrochanteric fracture (a type of broken bone in the upper part of the thigh bone (femur) near the hip, where the bone pieces are out of place) of the right femur and fracture (broken bone) of right lower leg. During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool) dated 11/5/2025, the MDS indicated Resident 1's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) was intact and Resident 1 was dependent (helper does all of the effort) on facility staff to complete her activities of daily living ([ADLs] activities such as bathing, dressing and toileting a person performs daily). During a review of Resident 1's Physician's Order dated 10/29/2025, the Physician's Order indicated Resident 1 was to receive Heparin Injection Solution 5000 units/milliliter ([ml] a unit of measurement), 1.0 ml injected subcutaneously (under the skin) every eight hours for DVT prophylaxis (treatment to prevent disease or infection from occurring or spreading). During a review of Resident 1's Change in Condition (COC) form dated 11/10/2025 and timed at 11:44 p.m., the COC form indicated Resident 1 reported to LVN 2 that her legs were swollen. The COC form indicated Resident 1's left lower extremity was observed to be swollen. The COC form indicated Resident 1's physician was made aware. During a review of Resident 1's Physician's Order dated 11/11/2025, the Physician's Order indicated an order for venous doppler (a medical ultrasound technique that uses high frequency sound waves to create images of the veins, primarily to check blood flow and detect any blockages or clots, commonly used to diagnose conditions such as DVTs) diagnostic test of Resident 1's left leg to rule out a DVT. During a review of Resident 1's Nursing Note dated 11/11/2025, the Nursing Note indicated the venous doppler diagnostic test could not be performed because a soft leg cast and leg brace were present on the resident's left leg. During a review of Resident 1's Physician's Order dated 11/11/2025, the Physician's Order indicated to transfer Resident 1 a GACH for further evaluation. The Nursing Note indicated Resident 1 was transferred to GACH via ambulance. During a review of the GACH's Emergency Department (ED) Encounter Note dated 11/11/2025, the ED Encounter Note indicated Resident 1 presented with bilateral (both) thigh swelling, worse on the left thigh, status post (indicates a patient has undergone a specific event or procedure in the past) multiple fractures after a car accident (date of care accident unknown). The ED Encounter Note indicated Resident 1 reported missing a dose of Heparin, had sudden swelling of her thigh, and her leg brace felt tighter. During a review of GACH's Ultrasound (a medical test that uses sound waves to create images of the inside of the body) of Resident 1's lower extremity dated 11/11/2025, the Ultrasound results indicated extensive acute (a condition that is severe and sudden in onset) DVTs of Resident 1's left lower extremity. During an interview on 12/1/2025 at 8:15 a.m., Resident 1 stated on 11/10/2025, her legs started to feel funny, as if they were swelling, she reported this to LVN 2 at the same time she reported to LVN 2 Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056188 If continuation sheet Page 8 of 11 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 056188 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Long Beach Care Center, Inc 2615 Grand Avenue Long Beach, CA 90815 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 that LVN 1 did not give the afternoon dose (2 p.m.) of Heparin. Resident 1 stated she went to physical therapy at 12:30 p.m. and stayed there for about 45 minutes to one hour and returned to her room around 1:45 p.m. Resident 1 stated she waited for LVN 1 to give her the Heparin, but LVN 1 did not. Resident 1 stated after the change of shift, she informed LVN 2 she did not receive her afternoon dose of Heparin. LVN 2 confirmed that it had not been given by calling LVN 1. Resident 1 stated LVN 2 told her documentation he reviewed (the MAR) indicated LVN 1 had given her the afternoon dose (2 p.m.) of Heparin. Resident 1 stated when LVN 2 called LVN 1, LVN 1 told LVN 2 he had forgotten to administer Resident 1's dose of Heparin. During an interview on 12/1/2025 at 11:01 a.m., LVN 2 stated on 11/10/2025 around 4:45 p.m., Resident 1 reported to him that she did not receive her afternoon dose of Heparin. LVN 2 stated he reviewed Resident 1's MAR which indicated the dose of Heparin had been given by LVN 1 at 2 p.m LVN 2 stated he called LVN 1 to clarify the administration of Heparin and LVN 1 informed him that he (LVN 1) forgot to give the dose of Heparin to Resident 1. LVN 2 stated throughout the shift (3 p.m. - 11 p.m.), Resident 1 complained that her left leg was swollen. LVN 2 stated he assessed Resident 1 when the resident initially complained but around 9 p.m. LVN 2 stated the resident's left leg swelling was obvious and he reported it to Registered Nurse (RN 2) and Resident 1's physician. During a telephone interview on 12/1/2025 at 12:23 p.m., LVN 1 stated at approximately 2:45 p.m., he was finishing his charting and Resident 1 had not returned from physical therapy yet, which was why he did not give Resident 1 her dose of Heparin. LVN 1 stated he accidentally documented that he administered the dose of Heparin to Resident 1, and he should not have done that. LVN 1 stated he did not think one missed dose of Heparin could contribute to the development of a DVT because he believed Heparin stayed in the body long enough to prevent DVTs from forming. During an interview on 12/3/2025 at 11:14 a.m., Resident 1's physician stated Resident 1 probably already had a DVT, but the missed dose of Heparin could have contributed to the DVTs increase in size. Resident 1's physician stated he reviewed the doppler results and confirmed Resident 1 had an extensive clot which ran the length of Resident 1's entire left thigh. Resident 1's physician stated along with other contributing factors such as the leg brace fitting too tight and Resident 1's immobility, the missed dose of Heparin did not help Resident 1's condition. During an interview on 12/3/2025 at 1:45 p.m., the Director of Nursing (DON) stated LVN 1 forgot to administer Resident 1's afternoon dose of Heparin because Resident 1 was in physical therapy and it was close to change of shift. The DON stated LVN 1 should have notified the MD about the missed dose of Heparin, monitor Resident 1 for any COC, notify the pharmacist, the Registered Nurse Supervisor (RNS), and the DON. During a review of the facility's undated Policy and Procedure (P/P) titled Medication Administration, the P/P indicated medications are administered by licensed nurses. as ordered by the physician and in accordance with professional standards of practice. During a review of facility's Job Description for Charge Nurse - RN/LVN, the Job Description indicated one of the charge nurse's specific job functions included administering and documenting medication and treatments in compliance with facility policy and procedure. Event ID: Facility ID: 056188 If continuation sheet Page 9 of 11 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 056188 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Long Beach Care Center, Inc 2615 Grand Avenue Long Beach, CA 90815 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 staff failed ensure a Medication Administration Record ([MAR] a daily documentation record used by a licensed nurse to document medications and treatments given to a resident) for one of four sampled residents (Resident 1) was not falsified, when Licensed Vocational Nurse (LVN) 1 documented he administered a dose of Heparin (a medication to prevent the formation of clots [masses of blood that form when blood cells stick together]) to Resident 1 on 11/10/2025 at 2 p.m., when he had not given it to her and then on 11/17/2025 documented another incorrect entry also indicating he had administered the Heparin dose to Resident 1. This deficient practice resulted in the inaccurate depiction of Resident 1's medication management and had the potential for non-continuity of care based on the inaccurate documentation. Findings: During a review of Resident 1's admission Record (Face Sheet), the Face Sheet indicated Resident 1 was admitted to the facility on [DATE] with a diagnosis of a displaced intertrochanteric fracture (a type of broken bone in the upper part of the thigh bone (femur) near the hip, where the bone pieces are out of place) of the right femur and fracture (broken bone) of right lower leg. During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool) dated 11/5/2025, the MDS indicated Resident 1's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) was intact and Resident 1 was dependent (helper does all of the effort) on facility staff to complete her activities of daily living ([ADLs] activities such as bathing, dressing and toileting a person performs daily). During a review of Resident 1's Physician's Order dated 10/29/2025, the Physician's Order indicated Resident 1 was to receive Heparin Injection Solution 5000 units/milliliter ([ml] a unit of measurement), 1.0 ml injected subcutaneously (under the skin) every eight hours for DVT prophylaxis (treatment to prevent disease or infection from occurring or spreading). During a review of Resident 1's MAR dated 11/10/2025 and timed at 2 p.m., the MAR indicated a 9 signifying Resident 1 was not available because she was participating in therapy and Resident 1 preferred to receive her medication after completing her session. During a review of Resident 1's Medication Administration Audit Report ([MAAR] document of medication administration in the exact time the record was documented by staff), the MAAR indicated Resident 1's Heparin was administered on 11/10/2025 at 2:18 p.m., continued documentation indicated a change to the original time and date for 11/17/2025 at 10:20 a.m. During an interview on 12/1/2025 at 8:15 a.m., Resident 1 stated on 11/10/2025, her legs started to feel funny, as if they were swelling, she reported this to LVN 2 at the same time she reported to LVN 2 that LVN 1 did not give the afternoon dose (2 p.m.) of Heparin. Resident 1 stated she went to physical therapy at 12:30 p.m. and stayed there for about 45 minutes to one hour and returned to her room around 1:45 p.m. Resident 1 stated she waited for LVN 1 to give her the Heparin, but LVN 1 did not. Resident 1 stated after the change of shift, she informed LVN 2 she did not receive her afternoon dose of Heparin. LVN 2 confirmed that it had not been given by calling LVN 1. Resident 1 stated LVN 2 told her documentation he reviewed (the MAR) indicated LVN 1 had given her the afternoon dose (2 p.m.) of Heparin. Resident 1 stated when LVN 2 called LVN 1, LVN 1 told LVN 2 he had forgotten to administer Resident 1's dose of Heparin. During an interview on 12/1/2025 at 11:01 a.m., LVN 2 stated on 11/10/2025 around 4:45 p.m., Resident 1 reported to him that she did not receive her afternoon dose of Heparin. LVN 2 stated he reviewed Resident 1's MAR which indicated the dose of Heparin had been given by LVN 1 at 2 p.m LVN 2 stated he called LVN 1 to clarify the administration of Heparin and LVN 1 informed him that he (LVN 1) forgot to give the dose of Heparin to Resident 1. LVN 2 stated throughout the shift (3 p.m. - 11 p.m.), (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056188 If continuation sheet Page 10 of 11 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 056188 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Long Beach Care Center, Inc 2615 Grand Avenue Long Beach, CA 90815 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 complained that her left leg was swollen. LVN 2 stated he assessed Resident 1 when the resident initially complained but around 9 p.m. LVN 2 stated the resident's left leg swelling was obvious and he reported it to Registered Nurse (RN 2) and Resident 1's physician. During a telephone interview on 12/1/2025 at 12:23 p.m., LVN 1 stated at approximately 2:45 p.m., he was finishing his charting and Resident 1 had not returned from physical therapy yet, which was why he did not give Resident 1 her dose of Heparin. LVN 1 stated he accidentally documented that he administered the dose of Heparin to Resident 1, and he should not have done that. LVN 1 stated he did not think one missed dose of Heparin could contribute to the development of a DVT because he believed Heparin stayed in the body long enough to prevent DVTs from forming. During a telephone interview on 12/1/2025 at 12:23 p.m., LVN 1 stated at approximately 2:45 p.m., he was finishing his charting and Resident 1 had not returned from physical therapy yet, which was why he did not give Resident 1 her dose of Heparin. LVN 1 stated he accidentally documented that he administered the dose of Heparin to Resident 1, and he should not have done that. LVN 1 stated he should not have documented that he gave Resident 1 her medication when he had not given it to her. LVN 1 stated when he returned to work on 12/17/2025, he edited Resident 1's medical records inaccurately. During an interview on 12/3/2025 at 1:45 p.m., the Director of Nursing (DON) stated he had spoken to LVN 1, who admitted he had forgotten to administer the 2 p.m., dose of Heparin on 11/10/2025 and that he had documented he had given the medication to Resident 1 when he had not given it to her. The DON stated LVN 1 was told to correct the documentation in Resident 1's record. The DON stated LVN 1 should have included late entry when the documentation was corrected. During a review of the facility's undated Policy and Procedure (P/P) titled Medication Administration the P/P indicated the MAR should be signed after the medication is administered. Event ID: Facility ID: 056188 If continuation sheet Page 11 of 11