Health inspection·January 9, 2026

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 provide care and services to ensure one of three sample residents (Resident 1) with blisters (a painful skin condition filled with fluid fills a space between layers of skin) due to shingles (an infection caused painful rash) was assessed, monitored and documented weekly for two weeks the skin condition in accordance with the facility's policy and procedures (P&P) titled, Wound Care. This deficient practice had the potential for Resident 1's to receive delayed care or no care when the resident's skin condition with blisters due to shingles to worsen, become infected, and could also spread to other vulnerable residents in the facility. Findings: During a review of Resident 1's admission Record (AR), the AR indicated the facility originally admitted Resident 1 on 5/20/2025 and readmitted on [DATE] with diagnoses that included anxiety disorder (a normal feeling of worry or fear in response to stress) and hypertension (high blood pressure). During a review of Resident 1's Minimum Data Set (MDS, a standardized assessment and care planning screening tool), dated 12/24/2025, the MDS indicated Resident 1 had moderately impaired cognitive (ability to understand and make decisions) skills for daily decision making. The MDS indicated Resident 1 required partial/moderate assistance with eating, oral hygiene, personal hygiene and chair/bed-to-chair transfer, and substantial/maximal assistance with toileting hygiene and shower/bathe self. During a review Resident 1's Physician Order, dated 12/24/2025, the order indicated the physician ordered to cleanse the shingles rash on bilateral buttocks in the morning with normal saline, pat dry, and cover with foam dressing daily for 14 days. During an interview on 1/8/2026 at 1:02 PM with Certified Nursing Assistant (CNA) 1, CNA 1 stated she assisted the Treatment Nurse (TXN) to assess Resident 1's skin when the resident was admitted to the facility on [DATE]. CNA 1 stated she saw Resident 1 had some red closed dots on her low back area and Resident 1 complained it was painful in that area. During a concurrent interview and record review on 1/8/2026 at 2:55 PM with the TXN, Resident 1's medical record was reviewed. The TXN stated Resident 1 had shingles and she saw red blisters on Resident'1 lower back area when she assessed Resident 1 on 12/19/2025. The TXN stated the Registered Nurse (RN) supervisor was responsible with documenting Resident 1's skin condition related to blisters, but the RN supervisor did not document the condition of the blisters in the resident's clinical record. The TXN stated the there was no documentation in Residen1's clinical record that indicated the resident's blisters was assessed, documented and monitored for two weeks since 12/19/2025 The TXN stated she was off for the past two weeks and the covering nurses did not assess and complete the Weekly Skin Check for Resident 1 from 12/26/2025 and 1/2/2026. The TXN stated it was important to assess the skin and document the assessment on the admission and weekly afterwards, so they could monitor the healing progress of the shingles and evaluate the effectiveness of the current treatment. The TXN stated if Resident 1's blisters condition worsens compared to the previous assessment; they could intervene immediately to prevent the wound and the infection from getting worse. During a concurrent interview Residents Affected - Few (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 2 Event ID: 056190 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 01/09/2026 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)