Health inspection·December 12, 2025

F 0600 Level of Harm - Actual harm Residents Affected - Few the resident's behavior is to not result in harm or injury to self or others. The care plan interventions included for facility staff to provide behavioral management or modification as needed, such as providing redirection when exhibiting inappropriate behavior. During a review of Resident 1's History and Physical (H&P) dated 5/24/2025, the H&P indicated Resident 1 did not have the capacity to understand and make decisions. The H&P indicated Resident 1 came from GACH 1 for altered mentation (confusion, not acting right, altered behavior), metabolic encephalopathy (brain dysfunction caused by illness) and dementia. During a review of a care plan developed for Resident 1 and initiated on 6/14/2025, the care plan indicated the resident has a behavioral problem of being physically aggressive related to pushing staff and throwing trash when entering her room. The care plan indicated that staff must intervene to protect the rights and safety of others, divert attention and remove Resident 1 from the situation and/or take to an alternate location. During a review of Resident 1's Minimum Data Set (MDS - a federally mandated resident assessment tool) dated 8/26/2025, the MDS indicated the resident had severe cognitive impairment (problems with a person's ability to think, learn, remember, use judgement, and make decisions). The MDS indicated Resident 1 was assessed requiring partial/moderate assistance for activities of daily living (basic self-care tasks). The MDS further indicated Resident 1 was assessed walking with partial/moderate staff assistance. The MDS further indicated Resident 1 manifested wandering behavior (a disturbance of motor activity that involves directionless, disoriented movement) and behavioral symptoms not directed towards (MDS examples indicated physical symptoms such as hitting or scratching self, pacing, rummaging, public sexual acts, disrobing in public, throwing or smearing food or bodily wastes or verbal/vocal symptoms like screaming, disruptive sounds). During a review of Resident 1's previous Change of Condition (COC) form dated 9/10/2025, authored by Registered Nurse (RN) 2, the COC indicated Resident 1's previous history of agitation observed by staff with escalating agitation. The COC further indicated that at 5:09 PM Resident 1 was yelling profanities (offensive language) at staff when staff enters her room. The COC indicated that Resident 1 throws water at the CNA and other staff passing her doorway. The COC indicated that Resident 1 was medicated with Haldol (a medication used to treat aggressive behavior) 5 milligrams (mg - unit of measure) intramuscularly (IM - injection under the muscle) and Benadryl (medication used to cause drowsiness) 25 mg IM one time. During a review of Resident 1's Nursing Progress Notes dated 11/13/2025 timed at 4:31 PM, the Note indicated another previous episode of agitation that indicated how Resident 1 was in an agitated state, had thrown water at staff and attempted to elope (a patient leaving a facility or designated safe area without authorization, often due to confusion). The Note indicated that the staff left her alone pacing up and down the hallway as to not trigger her anger. During a review of Resident 1's psychology (the scientific study of the human mind and its functions, especially those affecting behavior) note titled Behavioral Health documented on 11/24/2025 at 5:31 PM, the note indicated that Resident 1 reported to the psychologist that the resident was experiencing anxiety, frustration, and negative thinking patterns. The Note did not provide details regarding the specific situations or triggers that contributed to these symptoms. In addition, the Note did not include any recommendations or modifications to the treatment plan to address these concerns.The psychology note documented the following statements: Were there any treatment modifications needed in today's session due to cognitive impairment? No cognitive impairment noted. Medical Necessity for Ongoing Treatment: Symptoms Require More Attention, Risk of Significant Decline. During a review of Resident 1's Progress Notes dated 11/24/2025 documented at 10:40 PM, the Note indicated an incident happened around 10:30 PM when the [CNA 1] informed [Registered Nurse (RN) 1] that Resident 1 was playing with a wheelchair's metal footrests. The Notes indicated [CNA 1] tried to calm [Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056190 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 056190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chestnut Ridge Post Acute LLC 525 South Central Avenue Glendale, CA 91204 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 - Actual harm Residents Affected - Few 1] down and get the wheelchair footrests from [Resident 1], but the resident was swinging it [at] CNA 1. The Note indicated CNA 1 went to ask help from RN 1 but while walking back to Resident 1's room, a scream was heard from the roommate, [Resident 2]. The Note indicated that Resident 1's physician (MD 1) was notified and ordered to administer Haldol 5 mg and Benadryl 25 mg IM to [Resident 1]. The Note indicated that RN 1 entered [Resident 1's] room and the roommate, [Resident 2] was observed with multiple lacerations to her face. The Note indicated the Police Department was notified and a police report was filed with the local police department. During a review of Resident 1's physician's telephone order dated 11/25/2025 the order indicated to transfer Resident 1 to GACH 2 to rule out (r/t) agitation. During a review of Resident 1's Nursing Progress Note dated 11/25/2025 documented at 2:35 AM, the Note indicated that Resident 1 was taken to GACH 2 on 11/25/2025 at 12:52 AM for further behavioral evaluations related to agitation. During a review of Resident 1's Change of Condition (COC) dated 11/25/2025, the COC indicated that an incident occurred around 10:30 PM when [CNA 1] informed [RN 1] that Resident 1 was playing [with] the footrest of the wheelchair. She [CNA 1] tried to calm her (Resident 1) down but get the footrests from her, but she was swinging it [at] her. The Note indicated CNA 1 left the room and went to ask for help from RN 1, but while walking back to Resident 1's room, a scream was heard from the roommate, Resident 1. 2. During a review of Resident 2's AR, the AR indicated the facility admitted the resident on 9/15/2023, with a diagnosis of dementia with behavioral disturbance and anxiety disorder (experiencing excessive worry and fear). During a review of Resident 2's H&P dated 11/27/2025, the H&P indicated Resident 2 did not have the capacity to understand and make decisions. During a review of Resident 2's MDS dated [DATE], the MDS indicated that Resident 2 had severe cognitive impairment. The MDS indicated that Resident 2 required partial/moderate assistance for activities of daily living. The MDS further indicated that Resident 2 required partial/moderate assistance to move from sitting on her side of the bed to lying flat on the bed, to come to a standing position from sitting in a chair, wheelchair or on the side of the bed, and the ability to transfer to and from the bed to a chair. During a review of Resident 2's Nursing Progress Notes Type: Situation Background Assessment Recommendations [SBAR] dated 11/24/2025 timed at 11:14 PM, the Note indicated an incident occurred around 10:30 PM when [CNA 1] informed [RN 1] that Resident 1 was playing the footrest of the wheelchair. The Note indicated [CNA 1] tried to calm her (Resident 1) down and get the footrests from her, but [Resident 1] was swinging it [at] [CNA 1]. The Note indicated CNA 1 went to ask help from RN 1 but while walking back to Resident 1's room, a scream was heard from the roommate, [Resident 1]. The Note indicated that [Resident 2] was found with lacerations on her face and treatment was applied. During a review of Resident 2's Nursing Progress Notes dated 11/24/2025 timed at 11:14 PM, the Note indicated that Resident 2 was medicated with Acetaminophen (pain medication) 325 mg two tablets for 7 out of 10 (a severe level of pain on the standard 0 to 10 pain rating scale used by medical professionals to quantify subjective pain experiences) facial pain. During a review of Resident 1's Police Report dated 11/24/2025, documented by Police Officer (PO) 1 on 11/24/20925 at 11:58 PM, the report indicated that at approximately 11:57 PM, PO 1 responded to a call at the facility regarding a resident who struck another resident with a wheelchair footrest. The report indicated that Resident 1 was the individual who struck Resident 2. RN 1 stated that the incident occurred at approximately 10:40 PM, when CNA 1 was in Resident 1's shared bedroom and observed Resident 1 swinging wheelchair footrests she had removed from her wheelchair, attempting to strike CNA 1. PO 1 further indicated in the report that CNA 1 left the room to seek assistance, and shortly afterward, nursing staff heard screams coming from the shared bedroom. Staff entered the room and observed Resident 2 with severe laceration on her forehead. According to the report, LVN (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056190 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 056190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chestnut Ridge Post Acute LLC 525 South Central Avenue Glendale, CA 91204 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 - Actual harm Residents Affected - Few 1 called 911, and Resident 2 was transported to GACH 3 for treatment. During a review of Resident 2's COC Evaluation dated 11/25/2025, the COC indicated Resident 2 manifested acute pain (pain that comes on suddenly and is caused by something specific) to the face. The Pain Status Evaluation indicated Resident 2 was unable to rate the pain but noted with facial grimacing (distorted facial expression) with body language noted as rigid, fists clenched, knees pulled up. During a review of Resident 2's Nursing Progress Notes at the facility dated 11/25/2025, the Note indicated Resident 2 was transferred to GACH 3 on 11/25/2025 at 12:08 AM via ambulance assisted by two emergency medical technicians (EMT) for further evaluation of facial lacerations. During a review of Resident 2's GACH 3 records titled ‘emergency room (ER) Documentation dated 11/25/2025 timed at 12:35 AM, the GACH 3 record indicated Resident 2 was admitted to the ER for facial injuries. The GACH 3 record indicated that Resident 2 presented to the ER with altered mental status and had a number of lacerations on the face. The GACH 3 record indicated Resident 2 was assaulted by another resident [Resident 1] and she [Resident 2] was hit several times to the head, bleeding was controlled with steri-strips. The Record indicated that it was unknown if Resident 2 had lost consciousness after the assault. During a review of Resident 2's GACH 3 record titled Computerized Tomography of the head for moderate-severe head trauma, dated 11/25/2025 timed at 1:33 AM, the CT scan indicated Resident 2's forehead had a soft tissue hematoma (a medical condition characterized by the presence of localized bleeding and blood clot formation in the soft tissues of the bod), and there was no acute intracranial (within the skull) hemorrhage (bleeding) or fluid collection. During a review of Resident 2's GACH 3 records titled CT of the maxillofacial (jawbone and face) for facial trauma dated 11/25/2025 timed at 1:34 AM, the CT indicated Resident 2 had a forehead soft tissue hematoma as well as a right periorbital (around the eye socket) laceration. The CT indicated there was partial mild irregularity of the right nasal bone and there was a questionable right anterior nasal bone fracture. During a review of Resident's 2 Nursing Progress Note dated 11/25/2025 timed at 7:40 AM, the Note indicated the facility received a report from GACH 3 that Resident 2 had no intracranial injury noted and derma bond (surgical glue) was applied to the facial lacerations. The Note indicated Resident 2 was cleared by GACH 3 to return back to the facility. During a review of Resident 2's Nursing Progress Note dated 11/25/2025 at 8:15 AM, the progress note indicated that Resident 2 was readmitted back to the facility from GACH 3. During a review of Resident 2's MD Progress Note dated 11/26/25, the progress note indicated Resident 2 was attacked by another resident [Resident 1] without provocation on 11/24/2025 with the footrest of a wheelchair. The progress note indicated that Resident 2 did not remember what happened to her face and is full of cuts and bruises. During a concurrent observation and interview on 12/9/2025 at 10:25 AM with Resident 2 in her room, Resident 2 was noted to have visible facial injuries, including swelling, laceration and bruising to the center of the forehead, two scabbed lacerations above the right eyebrow, a scabbed laceration on the right cheek, and another scabbed laceration beneath the right nostril. Resident 2 was able to respond verbally to her name, however, Resident 2 could not state or recall how the facial injuries occurred. During an interview on 12/9/2025 at 11 AM with the Director of Nursing (DON), the DON stated that on 11/24/2025, Resident 1 was in an agitated state and was swinging two metal wheelchair footrests inside their (Residents 1, 2, and 3) room. According to the DON, CNA 1 witnessed Resident 1 swinging the dangerous metal object but was unable to remove the wheelchair footrests from Resident 1's hands. CNA 1 left the room to go to Nursing Station 1 to seek assistance. The DON stated that RN 1 and Licensed Vocational Nurse (LVN) 1 were on their way to Resident 1's room when they heard residents screaming. The DON stated while other staff (CNAs 2 and 3) tried to get Resident 1 under control, and when Resident 1 eventually calmed down, RN 1 entered the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056190 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 056190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chestnut Ridge Post Acute LLC 525 South Central Avenue Glendale, CA 91204 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 - Actual harm Residents Affected - Few room and observed that Resident 2 had sustained facial injuries after being struck by the metal wheelchair footrests that Resident 1 had been swinging in the air inside their shared room. During an interview on 12/9/2025 at 11:34 AM with RN 1, RN 1 stated that on 11/24/2025 at approximately 10:30 PM, she was at Nursing Station 1 when CNA 1 approached after leaving Resident 1's room. CNA 1 reported that Resident 1 was inside her room swinging two metal wheelchair footrests in an aggressive manner. CNA 1 stated she attempted to calm Resident 1 and remove the footrests but was unsuccessful. Feeling frightened, CNA 1 left the room to seek assistance, leaving Resident 1 unattended with her roommates, Residents 2 and 3. During the same interview on 12/9/2025 at 11:34 AM with RN 1, RN 1 stated that RN 1, Licensed Vocational Nurse (LVN) 1, and CNA 1 left the Nursing Station to respond to Resident 1's room and heard a loud scream. Upon arrival, RN 1 observed Resident 1 actively swinging the metal wheelchair footrests in front of her bed in an agitated state, preventing staff from safely entering the room to assess Resident 2. RN 1 stated that CNA 2 and CNA 3 removed Resident 1 from the room and restrained her against the hallway wall using a linen cart. RN 1 instructed LVN 1 to call the attending physician, who ordered Haldol 5 mg IM and Benadryl 25 mg IM for agitation. RN 1 stated that it took approximately 30 to 40 minutes for Resident 1 to calm down. During that time, Resident 1 remained agitated, pinned against the wall, and eventually slid to the floor. Once seated, Resident 1 released both metal wheelchair footrests. During another interview on 12/9/2025 at 12 PM with RN 1, RN 1 stated that when she was finally able to enter Resident 1's room at approximately 11:10 to 11:20 PM on 11/24/2025, Resident 2 was observed lying in bed with her face covered in blood. RN 1 stated that Resident 2 sustained a deep, open laceration to the center of the forehead, two open lacerations above the right eyebrow, an injury to the right cheek, and a small laceration beneath the right nostril. RN 1 stated she cleaned the wounds and applied steri-strips to the lacerations on the forehead, above the right eyebrow, the right cheek, and under the right nostril. RN 1 stated she applied a cold compress to the right side of Resident 2's face due to redness and swelling, administered Tylenol for severe pain, and initiated neurological checks (a quick, systematic way nurses assess a patient's brain function after a head injury). RN 1 stated Resident 1 was placed on one-to-one observation (assigning a dedicated staff member to continuously monitor a patient for safety ensuring they are constantly within sight) at Nursing Station 1. During the same interview on 12/9/2025 at 12:00 PM with RN 1, RN 1 further stated that CNA 1 should have remained in Resident 1's room, utilized diversion techniques (a non-pharmacological method used to temporarily shift a patient's focus away from pain, anxiety, or discomfort by engaging them in other activities), and called out for assistance rather than leaving Resident 1 unattended with her roommates, Residents 2 and 3, still inside the shared room. RN 1 stated that CNA 1 leaving the room while Resident 1 was agitated and holding two metal footrests, with Residents 2 and 3 still present, resulted in Resident 2 being struck by the metal wheelchair footrests and sustaining multiple facial lacerations. During an interview on 12/9/2025 at 12:48 PM, CNA 4 stated she had been previously assigned to care for Residents 1, 2 and 3. CNA 4 stated that Resident 1 was ambulatory (able to walk), while Residents 2 and 3 were bedbound (unable to leave their beds to walk independently). CNA 4 stated that Resident 2 had severe dementia and limited ability to verbally communicate needs, whereas Resident 3 was alert and oriented and able to verbally communicate needs, but required moderate assistance with activities of daily living. CNA 4 reported frequently observing Resident 1 sitting up in bed talking to herself. CNA 4 further stated that Resident 3 reported witnessing Resident 1 strike Resident 2 with the metal wheelchair footrests on 11/24/2025, prompting Resident 3 to scream for help. During an interview on 12/9/2025 at 1:30 PM with Resident 3, Resident 3 stated that on the night of 11/24/2025, Resident 1 was in an agitated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056190 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 056190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chestnut Ridge Post Acute LLC 525 South Central Avenue Glendale, CA 91204 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 - Actual harm Residents Affected - Few state and threw a cup of water from her bedside table. Resident 3 reported witnessing Resident 1 grab two metal wheelchair footrests, wave them around the room, and pace (walk at a steady and consistent speed, especially back and forth and as an expression of one's anxiety) back and forth from the doorway to the back of the room. Resident 3 stated that CNA 1 entered the room and attempted to remove the metal footrests from Resident 1's hands but was unsuccessful and then left the room. Resident 3 stated that after CNA 1 left the room, Resident 1 turned and approached Resident 3, who was lying in bed, and came within approximately four feet, and attempted to strike her (Resident 3) with the metal footrests. Resident 3 stated she was able to yell at Resident 1 to leave her alone. Resident 3 stated that Resident 1 then turned toward Resident 2's bed, who was also in bed. Resident 3 stated she heard the sound of the metal footrests as Resident 1 struck Resident 2 and screamed for help. Although a privacy curtain obstructed her view of Resident 2's upper body, Resident 3 observed Resident 1's body movements consistent with striking Resident 2 and heard the impact. Resident 3 stated she was frightened and feared for her life. Resident 3 stated that Resident 2 was unable to defend herself due to being bedbound. Resident 3 stated that after the physical assault against Resident 1, a nurse (RN 1) arrived and assisted Resident 2 with her injuries. During an interview on 12/9/2025 at 2:22 PM with CNA 1, CNA 1 stated that at the start of her shift on 11/24/2025 at approximately 3:30 PM, Resident 1 was observed sitting up in bed and talking to herself. CNA 1 stated that at approximately 10:30 PM, she observed Resident 1 standing at the entrance of her shared room, swinging two metal wheelchair footrests-one in each hand-in a crosswise back-and-forth motion. CNA 1 stated she approached Resident 1 and attempted verbal redirection, however, Resident 1 was not redirectable and swung the footrests toward CNA 1, nearly striking her. CNA 1 stated Resident 1 appeared highly agitated and had an intense facial expression. CNA 1 stated she left Resident 1's room and walked to Nursing Station 1, located down the hallway and notified RN 1 and LVN 1. CNA 1 stated that other CNAs (CNA 2 and CNA 3) responded and were able to remove Resident 1 from the room and restrain her against the hallway wall until Resident 1 slid to a seated position on the floor and released the wheelchair footrests from her hands. During the same interview on 12/9/2025 at 2:22 PM with CNA 1, CNA 1 stated that she entered Resident 1's room with RN 1 at approximately 11:30 PM (after Resident 1 calmed down) and observed Resident 2 lying in bed with her face covered in blood. CNA 1 stated that Resident 1 was then taken to Nursing Station 1 for observation. CNA 1 acknowledged that she should have remained in the room, called out for assistance, and maintained oversight of Resident 1. CNA 1 stated she left Resident 1 in the room due to fear of being struck by the metal wheelchair footrests. CNA 1 further stated that when she left the room, Residents 2 and 3 were left alone at-risk form harm due to Resident 1's agitated state and possession of a dangerous object. CNA 1 stated that she should have remained in the room and yelled for help instead. CNA 1 also stated that licensed nursing staff typically overhead page for assistance when incidents like these (agitated resident in possession of a dangerous object) happens, which did not occur in this situation. During an interview on 12/9/2025 at 3:15 PM with the Director of Staff Development (DSD), the DSD stated that staff had received education regarding abuse, including physical abuse and resident-to-resident altercations. During a concurrent review of the facility's Abuse Policy with the DSD, the DSD stated that the policy required staff to understand resident behaviors and symptoms that increase the risk for abuse and how to respond. However, the DSD stated that the facility's Abuse Policy did not provide specific guidance on how staff should respond to an agitated resident in possession of a dangerous object or how to prevent harm to residents and staff. The DSD stated that the facility did not have a designated code alert for an agitated resident with a dangerous object, although staff could use overhead paging to request (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056190 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 056190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chestnut Ridge Post Acute LLC 525 South Central Avenue Glendale, CA 91204 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 - Actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete assistance. The DSD stated that CNA 1 should have remained with Resident 1, who was agitated and holding two metal wheelchair footrests, and that by leaving the room to obtain assistance, CNA 1 left Residents 2 and 3 unattended. During a phone interview on 12/12/2025 at 2 PM with PO 1, PO 1 stated he arrived at the facility at approximately 11:57 PM on 11/24/2025. PO 1 stated upon arrival into the facility, RN 1 informed him that Resident 1 had struck Resident 2 in the head and described the incident as an alleged accident. PO 1 further stated that [CNA 1] left Resident 1's room to seek assistance, and shortly afterward, nursing staff heard screams coming from Resident 1, 2, and 3's shared bedroom. PO 1 stated that when the staff [RN 1] entered the room, the staff observed Resident 2 with severe laceration on her forehead. During a review of the facility's policy and procedure (P&P) titled Abuse Prevention/Prohibition revised on 11/2018, the P&P indicated the facility does not condone any form of resident abuse, neglect . and develops facility policies, procedures, training programs, and systems in order to promote an environment free from abuse and mistreatment. During a review of the facility P&P titled Resident to Resident Altercation revised on 9/2022, the P&P indicated that behaviors that may provoke a reaction by residents or others included verbally aggressive behavior, such as screaming, cursing, bossing around/demanding, insulting to race or ethnic group, intimidating, physically aggressive behavior, such as hitting, kicking, grabbing, scratching, pushing/shoving, biting, spitting, threatening gestures, throwing objects. During a review of the facility P&P titled Resident Safety revised on 7/2017, the P&P indicated that resident safety and supervision and assistance to prevent accidents are facility-wide priorities. The P&P indicated that implementing interventions to reduce accident risks and hazards shall include the following: communicating specific interventions to all relevant staff, assigning responsibility for carrying out interventions, providing training, as necessary, ensuring that interventions are implemented. The P&P indicated that monitoring the effectiveness of interventions shall include the following: ensuring that interventions are implemented correctly and consistently, evaluating the effectiveness of interventions, modifying or replacing interventions as needed and evaluating the effectiveness of new or revised interventions. Event ID: Facility ID: 056190 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 056190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chestnut Ridge Post Acute LLC 525 South Central Avenue Glendale, CA 91204 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 0745 Provide medically-related social services to help each resident achieve the highest possible quality of life. 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 provide medically related social services for one of three sampled residents (Resident 3) by not ensuring the resident attained or maintained his/her highest practicable physical, mental, or psychosocial well-being. Specifically, facility staff did not identify or address factors negatively affecting Resident 3's psychosocial functioning after the resident witnessed and was exposed to a violent incident (physical abuse) involving another resident (Residents 1 and 2). No nursing or facility staff checked or followed up on Resident 3 following the incident. This deficient practice had the potential to result in long-term psychosocial harm as resident 3 verbalized experiencing fear, anxiety, and emotional distress after witnessing and being threatened during a violent incident. These deficiencies may further lead to depression and/or post-traumatic stress disorder (PTSD) symptoms, thereby reducing Resident 3's sense of security and quality of life. Findings: During a review of Resident 1's admission Record (AR), the AR indicated the facility admitted the resident to the facility on 5/22/2025, with diagnoses including dementia (a general term for a decline in thinking, memory, and reasoning skills severe enough to interfere with daily life) with behavioral disturbance (loss of memory and thinking ability with agitation and physical aggression), psychosis ( loses of touch with reality, experiencing symptoms like hallucinations (seeing/hearing things not there) and delusions (false beliefs), along with confused thinking and speech. During a review of Resident 1's History and Physical (H&P) dated 5/24/2025, the H&P indicated Resident 1 did not have the capacity to understand and make decisions. The H&P indicated Resident 1 came from GACH 1 for altered mentation, metabolic encephalopathy and dementia. ? During a review of Resident 1's Minimum Data Set (MDS - a federally mandated resident assessment tool) dated 8/26/2025, the MDS indicated the resident had severe cognitive impairment (problems with a person's ability to think, learn, remember, use judgement, and make decisions). MDS indicated that Resident 1 was partial/moderate assistance for activities of daily living (basic self-care tasks). The MDS further indicated that Resident 1 was able to walk 50 feet with two turns with partial/moderate assistance.?The MDS further indicated Resident 1 manifested wandering behavior and behavioral symptoms not directed towards (MDS examples indicated physical symptoms such as hitting or scratching self, pacing, rummaging, public sexual acts, disrobing in public, throwing or smearing food or bodily wastes or verbal/vocal symptoms like screaming, disruptive sounds). ? During a review of Resident 3's AR, the AR indicated the facility admitted the resident on 6/3/2024, with a diagnosis of type 2 diabetes (high blood sugar levels) and anxiety disorder (experiencing excessive worry and fear). During a review of Resident 3's H&P dated 11/27/2025, the H&P indicated Resident 3 did not have the capacity to understand and make decisions. During a review of Resident 3's MDS dated [DATE], the MDS indicated the Resident 3 cognition was moderately impaired. The MDS indicated that Resident 3 toileting hygiene required substantial/maximal assistance. The MDS indicated that Resident 3 was partial/moderate assistance for lying and sitting on the side of the bed, sit to stand and chair/bed to chair transfer. During a review of Resident 1's Progress Notes dated 11/24/2025 documented at 10:40 PM, the Note indicated an incident happened around 10:30 PM when the [CNA 1] informed [Registered Nurse (RN) 1] that Resident 1 was playing with a wheelchair's metal footrests. The Notes indicated [CNA 1] tried to calm [Resident 1] down and get the wheelchair footrests from [Resident 1], but the resident was swinging it [at] CNA 1. The Note indicated CNA 1 went to ask help from RN 1 but while walking back to Resident 1's room, a scream was heard from the roommate, [Resident 2]. The Note indicated that Resident 1's physician (MD 1) was notified and ordered to administer Haldol 5 mg and Benadryl 25 mg IM to [Resident 1]. The Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056190 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 056190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chestnut Ridge Post Acute LLC 525 South Central Avenue Glendale, CA 91204 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 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Note indicated that RN 1 entered [Resident 1's] room and the roommate, [Resident 2] was observed with multiple lacerations to her face. The Note indicated the Police Department was notified and a police report was filed with the local police department. During a review of Resident 1's physician's telephone order dated 11/25/2025 the order indicated to transfer Resident 1 to GACH 2 to rule out (r/t) agitation. During a review of Resident 1's Nursing Progress Note dated 11/25/2025 documented at 2:35 AM, the Note indicated that Resident 1 was taken to GACH 2 on 11/25/2025 at 12:52 AM for further behavioral evaluations related to agitation. During a review of Resident 1's Change of Condition (COC) dated 11/25/2025, the COC indicated that an incident occurred around 10:30 PM when [CNA 1] informed [RN 1] that Resident 1 was playing [with] the footrest of the wheelchair. She [CNA 1] tried to calm her (Resident 1) down but get the footrests from her, but she was swinging it [at] her. The Note indicated CNA 1 left the room and went to ask for help from RN 1, but while walking back to Resident 1's room, a scream was heard from the roommate, Resident 1. During a review of Resident 1's Police Report dated 11/24/2025, documented by Police Officer (PO) 1 on 11/24/20925 at 11:58 PM, the report indicated that at approximately 11:57 PM, PO 1 responded to a call at the facility regarding a resident who struck another resident with a wheelchair footrest. The report indicated that Resident 1 was the individual who struck Resident 2. RN 1 stated that the incident occurred at approximately 10:40 PM, when CNA 1 was in Resident 1's shared bedroom and observed Resident 1 swinging wheelchair footrests she had removed from her wheelchair, attempting to strike CNA 1. PO 1 further indicated in the report that CNA 1 left the room to seek assistance, and shortly afterward, nursing staff heard screams coming from the shared bedroom. Staff entered the room and observed Resident 2 with severe laceration on her forehead. According to the report, LVN 1 called 911, and Resident 2 was transported to GACH 3 for treatment. During an interview on 12/9/2025 at 11 AM with the Director of Nursing (DON), the DON stated that on 11/24/2025, Resident 1 was in an agitated state and was swinging two metal wheelchair footrests inside their (Residents 1, 2, and 3) room. According to the DON, CNA 1 witnessed Resident 1 swinging the dangerous metal object but was unable to remove the wheelchair footrests from Resident 1's hands. CNA 1 left the room to go to Nursing Station 1 to seek assistance. The DON stated that RN 1 and Licensed Vocational Nurse (LVN) 1 were on their way to Resident 1's room when they heard residents screaming. The DON stated while other staff (CNAs 2 and 3) tried to get Resident 1 under control, and when Resident 1 eventually calmed down, RN 1 entered the room and observed that Resident 2 had sustained facial injuries after being struck by the metal wheelchair footrests that Resident 1 had been swinging in the air inside their shared room. During an interview on 12/9/2025 at 11:34 AM with RN 1, RN 1 stated that on 11/24/2025 at approximately 10:30 PM, she was at Nursing Station 1 when CNA 1 approached after leaving Resident 1's room. CNA 1 reported that Resident 1 was inside her room swinging two metal wheelchair footrests in an aggressive manner. CNA 1 stated she attempted to calm Resident 1 and remove the footrests but was unsuccessful. Feeling frightened, CNA 1 left the room to seek assistance, leaving Resident 1 unattended with her roommates, Residents 2 and 3. During the same interview on 12/9/2025 at 11:34 AM with RN 1, RN 1 stated that RN 1, Licensed Vocational Nurse (LVN) 1, and CNA 1 left the Nursing Station to respond to Resident 1's room and heard a loud scream. Upon arrival, RN 1 observed Resident 1 actively swinging the metal wheelchair footrests in front of her bed in an agitated state, preventing staff from safely entering the room to assess Resident 2. RN 1 stated that CNA 2 and CNA 3 removed Resident 1 from the room and restrained her against the hallway wall using a linen cart. During another interview on 12/9/2025 at 12 PM with RN 1, RN 1 stated that when she was finally able to enter Resident 1's room at approximately 11:10 to 11:20 PM on 11/24/2025, Resident 2 was observed lying in bed with her face covered in blood. During (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056190 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 056190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chestnut Ridge Post Acute LLC 525 South Central Avenue Glendale, CA 91204 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 0745 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few an interview on 12/9/2025 at 12:48 PM with Certified Nursing Assistant (CNA 4), CNA 4 stated that Resident 1 was ambulatory and that her roommate Resident 3 was a bedbound resident and that was vulnerable. CNA 4 stated that Resident 3 was alert, orientated and required full assistance for Activities of Daily Living care (helping residents with essential self-care tasks they can't do alone, like?eating, bathing, dressing, using the toilet, grooming, and moving around). CNA 4 stated that she had observed Resident 1 sitting up in bed and having a conversation with herself on 11/24/2025 at the start of her shift at 3:30 PM. CNA 4 stated that Resident 1 had thrown a cup of water at staff a few times when she got upset. CNA 4 stated that Resident 3 had told her she had witnessed Resident 1 in an agitated state and was pacing back and forth inside their room. During an interview on 12/9/2025 at 1:30 PM with Resident 3, Resident 3 stated that on the night of 11/24/2025, Resident 1 was in an agitated state and threw a cup of water from her bedside table. Resident 3 reported witnessing Resident 1 grab two metal wheelchair footrests, wave them around the room, and pace (walk at a steady and consistent speed, especially back and forth and as an expression of one's anxiety) back and forth from the doorway to the back of the room. Resident 3 stated that CNA 1 entered the room and attempted to remove the metal footrests from Resident 1's hands but was unsuccessful and then left the room. Resident 3 stated that after CNA 1 left the room, Resident 1 turned and approached Resident 3, who was lying in bed, and came within approximately four feet, and attempted to strike her (Resident 3) with the metal footrests. Resident 3 stated she was able to yell at Resident 1 to leave her alone. Resident 3 stated that Resident 1 then turned toward Resident 2's bed, who was also in bed. Resident 3 stated she heard the sound of the metal footrests as Resident 1 struck Resident 2 and screamed for help. Although a privacy curtain obstructed her view of Resident 2's upper body, Resident 3 observed Resident 1's body movements consistent with striking Resident 2 and heard the impact. Resident 3 stated she was frightened and feared for her life because she did not want to get hit with the wheelchair footrests. Resident 3 stated that Resident 2 was unable to defend herself due to being bedbound. Resident 3 stated that after the physical assault against Resident 2, a nurse (RN 1) arrived and assisted Resident 2 with her injuries. Resident 3 stated that none of nurses or facility staff came to check up on her. Resident 3 stated that she was afraid that Resident 1 would return back to their room. During an interview on 12/9/2025 at 4:00 PM with Registered Nurse (RN 1), RN 1 stated she was unaware that Resident 3 had also been confronted by Resident 1. RN 1 reported she did not know Resident 3 had been threatened by Resident 1 on 11/24/2025 with the metal wheelchair footrests. RN 1 acknowledged she had forgotten to check on Resident 3's well-being. RN 1 further stated she should have assessed Resident 3 for emotional trauma or distress resulting from witnessing the violent incident and fearing injury from Resident 1. RN 1 also stated she should have notified the facility's Social Services Designee (SSD) to follow up and check on Resident 3. During an interview on 12/9/2025 at 4:10 PM with the Director of Nursing (DON), the DON stated she was unaware that Resident 3 had been emotionally traumatized by Resident 1's aggressive behavior when attempting to attack her with the metal wheelchair footrests. The DON stated that RN 1 should have assessed Resident 3's psychosocial well-being. The DON further stated that Resident 3 might be experiencing post-traumatic stress disorder (PTSD) and anxiety. The DON acknowledged that the Social Services Designee (SSD) should have assessed Resident 3 for psychosocial distress. During a review of the facility P&P titled Social Services revised on 9/2021, the P&P indicated that the facility provides medically related social services to assure that each resident can attain or maintain his/her highest practicable physical, mental, or psychosocial well-being. The P&P indicated that the facility staff is able to identify and address factors that have a potentially negative effect on psychosocial functioning of a resident for (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056190 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 056190 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/12/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Chestnut Ridge Post Acute LLC 525 South Central Avenue Glendale, CA 91204 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 0745 Level of Harm - Minimal harm or potential for actual harm example: skills, and/or resident to resident altercations, abuse of any kind, and behavioral problems (i.e., confusion, anxiety, loneliness, depressed mood, anger, fear, wandering, psychotic episodes). The P&P indicated that the social worker/social services staff are responsible for providing or arranging for mental and psychosocial counseling services, as needed and identifying and seeking ways to support resident needs through the assessment and care planning process. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056190 If continuation sheet Page 11 of 11