Health inspection·December 18, 2025

F 0600 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete at 9:18 a.m. and a subsequent interview at 1:45 p.m., the Activities Assistant (AA) stated he was on the smoking patio monitoring the residents when he saw Resident 1 punch Resident 2 on the left side of his chest. The AA stated he was the only staff member present on the smoking patio when the incident occurred. During an interview on 12/18/2025 at 2 p.m., Licensed Vocational Nurse (LVN) 1 stated on 12/5/2025, he saw Resident 1 trying to leave through the front door. LVN 1 notified the Director of Nursing (DON), who placed Resident 1 on one-to-one monitoring due to his exit-seeking behavior. LVN 1 stated the AA was present on the smoking patio to provide smoking supplies and to monitor the residents who were smoking but the AA was not assigned as Resident 1's one-to-one monitor. During an interview on 12/18/2025 at 2:56 p.m., the DON stated Resident 1 needed one-to-one monitoring due to prior verbal aggression and exit-seeking behavior. The DON stated the assignment for the one-to-one monitoring for Resident 1 was missed. The DON stated, an assigned one-to-one staff would have been immediately beside Resident 1, potentially preventing the incident between Resident 1 and Resident 2 from occurring. 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, other residents . Event ID: Facility ID: 056188 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 056188 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure the care plan for one of four sampled residents (Resident 1) whose interventions included one-to-one-monitoring (a care approach where a dedicated staff member is assigned to closely observe and attend to the needs of a specific resident. This level of monitoring is crucial in managing residents with aggressive tendencies or other complex needs, ensuring that any potential incidents can be promptly addressed) was implemented. This deficient practice resulted in Resident 1 not being provided one-to-one-monitoring, Resident 2 being left unsupervised and punching Resident 2 on the left side of his chest. This deficient practice had the potential for continued assault to Resident 2 as well as other residents who resided in the facility. 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 schizophrenia (a mental illness that is characterized by disturbances in thought). During a review of Resident 1's Minimum Data Set ([MDS] a resident assessment tool) dated 10/2/2025, the MDS indicated Resident 1's cognition (the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses) was moderately impaired and Resident 1 required supervision or touch assistance (helper provides verbal cues and/or touching steadying and/or contact guard assistance as resident complete activity) from facility staff to complete his activities of daily ([ADLs] activities such as bathing, dressing and toileting a person performs daily). Resident 1's MDS indicated Resident 1 exhibited physical behavior symptoms such as kicking, hitting and pushing towards others. During a review of Resident 1's Care Plan dated 12/4/2025, the Care Plan indicated Resident 1 had a potential for complications related to episodes of yelling/screaming, verbal aggression, and attempts to strike out at staff. Under this Care Plan a goal for Resident 1 was to minimize his behaviors daily. The Care Plan's interventions included one-to-one monitoring for Resident 1. During a review of Resident 1's COC form dated 12/7/2025, the COC form indicated while on the smoking patio, Resident 1 put his hands on another resident's (Resident 2) left chest and activity staff immediately separated both residents. During an interview on 12/18/2025 at 9:16 a.m., Resident 2 stated he was on the smoking patio, just standing there when Resident 1 out of nowhere punched him (Resident 2) on the left side of his chest. During an interview on 12/18/2025 at 9:18 a.m. and a subsequent interview at 1:45 p.m., the Activities Assistant (AA) stated he was on the smoking patio monitoring the residents when he saw Resident 1 punch Resident 2 on the left side of his chest. The AA stated he was the only staff member present on the smoking patio when the incident occurred. During an interview on 12/18/2025 at 2 p.m., Licensed Vocational Nurse (LVN) 1 stated on 12/5/2025, he saw Resident 1 trying to leave through the front door. LVN 1 notified the Director of Nursing (DON), who placed Resident 1 on one-to-one monitoring due to his exit-seeking behavior. LVN 1 stated the AA was present on the smoking patio to provide smoking supplies and to monitor the residents who were smoking but the AA was not assigned as Resident 1's one-to-one monitor. LVN 1 stated one-to-one monitoring was on Resident 1's care plan and should have been followed, it was an intervention created after Resident 1 had a previous episode of yelling and being aggressive to staff. During an interview on 12/18/2025 at 2:56 p.m., the DON stated Resident 1 needed one-to-one monitoring due to prior verbal aggression and exit-seeking behavior. The DON stated the assignment for the one-to-one monitoring for Resident 1 was missed. The DON stated, an assigned one-to-one staff would have been immediately beside Resident 1, potentially preventing the incident between Resident 1 and Resident 2 from occurring. During a review of the facility's undated Policy and Procedure (P/P) titled Comprehensive Care Plans, the P/P indicated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056188 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 056188 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/18/2025 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 0656 Level of Harm - Minimal harm or potential for actual harm the facility will develop and implement a comprehensive person centered care plan for each resident, consistent with resident rights, that includes measurable objectives and timeframes to meet a resident's medical, nursing and mental and psychosocial needs that are identified in the resident's comprehensive assessment. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056188 If continuation sheet Page 4 of 4