Health inspection·December 15, 2025

F 0684 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some alginate and cover with DD. Apply Zinc Oxide to Sacro-coccyx topically everyday shift for healed wound management. A review of Resident 2's admission Record indicated Resident 2 was admitted to the facility on [DATE] with diagnoses of dementia (progressive impaired ability to think, remember or make decisions that interferes with doing everyday activities) and difficulty in walking. A review of Resident 2's MDS, dated [DATE], indicated Resident 2 had moderate impaired cognition (ability to think, remember and reason) for decisions of daily living, and required supervision (Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently) for eating, partial assistance (Helper does LESS THAN HALF the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort) for oral hygiene, and maximal assistance for toileting, showering, upper and lower body dressing, putting on taking off footwear, personal hygiene, rolling left and right, sit to lying, lying to sitting on side of bed, and chair transfer. The MDS indicated Resident 2 was at risk of developing pressure injuries. A review of Resident 2's Order Summary, dated 6/4/2025, indicated to monitor functionality of low air loss mattress (LAL, a bed that alternates pressure to help heal and prevent pressure injuries) every shift for skin management. A review of Resident 3's admission Record, the admission Record indicated Resident 3 was admitted to the facility on [DATE] with diagnoses of contractures (the permanent tightening and shortening of muscles, tendons, skin, or other tissues around a joint, making it stiff, difficult to bend or straighten, and restricting normal movement, often caused by injury, nerve damage, inactivity, scarring ) to arms and ankle, and muscle weakness. A review of Resident 3's MDS, dated [DATE], indicated Resident 3 had intact cognition for daily decision making. The MDS indicated Resident 3 required set up assistance (Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity) for eating, oral hygiene, partial assistance (Helper does LESS THAN HALF the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort) for toileting, showering, upper body dressing, rolling left and right, sit to lying and lying to sitting on side of bed. The MDS indicated Resident 3 required maximal assistance (Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) for putting on taking off footwear, lower body dressing and personal hygiene. The MDS indicated Resident 3 was at risk of developing pressure injuries. A review of Resident 3's Order Summary, dated 11/7/2024, indicated to apply A/D ointment to bilateral extremities and as barrier cream every shift for skin maintenance. A review of Resident 4's admission Record, the indicated Resident 4 was admitted to the facility on [DATE] with diagnosis of hemiplegia (loss of ability to move one one side of the body) and hemiparesis (one-sided muscle weakness caused by a disruption of the brain, spinal cord, or nerves connected to the affected muscles). A review of Resident 4's MDS, dated [DATE], indicated Resident 4 had moderate impaired cognition for daily decision making. The MDS indicated Resident 4 required set up assistance for eating, maximal assistance for oral hygiene, toileting, showering, upper body dressing, putting on taking off footwear, personal hygiene, partial assistance to roll left and right, sit to lying, lying to sitting on side of bed, and dependent (Helper does ALL of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity) on staff for lower body dressing. The MDS indicated Resident 4 was at risk of developing pressure injuries. A review of Resident 4's Order Summary, dated 10/20/2025, indicated to monitor skin integrity under cast (left arm) every day and evening shift. A review of Resident 5's admission Record, indicated Resident 5 was admitted to the facility on [DATE] with diagnoses of pressure injury to left buttock and open wound left foot. A review of Resident 5's MDS, dated (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056206 If continuation sheet Page 2 of 6 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 056206 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE University Park Healthcare Center 230 E Adams Blvd Los Angeles, CA 90011 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 - Some FORM CMS-2567 (02/99) Previous Versions Obsolete [DATE], indicated Resident 5 had severely impaired cognition for daily decision making. The MDS indicated Resident 5 was dependent on staff for oral hygiene, toileting, showering, upper and lower body dressing, putting on taking off footwear, personal hygiene, rolling left and right, sit to lying, lying to sitting on side of bed. The MDS indicated Resident 5 was at risk of developing pressure injuries. A review of Resident 5's Order Summary, dated 11/6/2025, indicated cleanse gastrostomy site with NS and apply dry dressing daily every shift. Apply Santyl ointment to left foot, left plantar, right heel, right ischium, right lateral foot stump, topically every day for 30 days. Monitor functionality of LAL mattress every shift for wound management, and provide catheter care (A catheter which is inserted into the bladder, via the urethra or abdomen and remains in place to drain urine) every shift. A review of the Treatment Administration Record (TAR), dated 11/29/2025 and 12/1/2025, the TAR indicated physician-ordered daily wound care was not provided on scheduled days for Residents 1, 2, 3, 4, and 5. During an interview on 12/15/2025 at 1:27 PM with the Treatment Nurse (TN), the TN stated he is the only full time TN at the facility, and was scheduled to work on 12/1/2025 but was unable to attend his shift. The TN verified treatments provided to residents on 11/29/2025 and 12/1/2025 on the electronic medical record and stated Residents 1, 2, 3, 4, and 5 had not been provided treatment on those days per physician's order. The TN stated there was no documentation indicating treatment was completed, refused, or held. During an interview on 12/15/2025 at 1:58 PM with the Registered Nurse Supervisor (RNS), the RNS stated he worked on 12/1/2025 and was aware there was no assigned treatment nurse during the shift. The RNS stated he did not provide the ordered treatments, did not reassign another licensed nurse to complete treatments, nor was informed of residents who didn't receive treatment. The RNS also verified that treatments for residents on 11/29/2025 was not provided by the treatment nurse assigned that day. The RNS stated the treatment nurse on 11/29/2025 did not report the missed treatments to anyone, including the physician. During an interview on 12/15/2025 at 2:15 PM with the Director of Nursing (DON), the DON stated the facility failed to assign a treatment nurse on 12/1/2025 which resulted in Residents 1, 2, 3, 4, and 5 not receiving treatment as ordered per physician. The DON stated she assigned herself to provide treatment on 12/1/2025 because she could not find anyone to provide treatment despite having licensed nurses in the facility that day. The DON stated she did not prioritize residents who required extensive treatment, or had more complicated wounds, hoping she could provide treatment to all residents with physician orders, but failed to complete treatments for at least five residents. The DON stated it is important to follow physician's orders to ensure residents are being provided with the necessary treatment and services to treat resident's diagnosis based on the clinical judgment of the ordering physician. The DON stated this failure placed residents at risk for deteriorating skin integrity. A review of the facility policy and procedures (P&P) titled Medication and Treatment Orders dated 7/2016, indicated, Medications and treatments shall be administered only upon the written order of a person licensed and authorized to prescribe such medications and treatments. A review of the facility P&P titled Competency of Nursing Staff dated 11/2025, indicated, Licensed nurses will demonstrate competencies deemed necessary to care for the needs of residents as identified through resident assessments and described in the plans of care. The staff development and training program is created by the nursing leadership, with input from the medical director, and is designed to train nursing staff to deliver individualized, safe, quality care and services for the residents. Competency in skills and techniques necessary to care for residents' needs includes but is not limited to competencies in areas such as skin and wound care. Event ID: Facility ID: 056206 If continuation sheet Page 3 of 6 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 056206 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE University Park Healthcare Center 230 E Adams Blvd Los Angeles, CA 90011 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 0686 Provide appropriate pressure ulcer care and prevent new ulcers from developing. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Cross Reference F684 Based on interview, and record review, the facility failed to ensure physician orders were implemented on 11/29/2025 and 12/1/2025 for five out of five sampled residents (Resident 1, Resident 2, Resident 3, and Resident 5), who required daily treatment for wound (a physical injury to the body, like a cut or tear in the skin) management to prevent the development of and or deterioration of pressure injuries (Pressure sore/ulcer-is localized damage to skin and underlying tissues from intense or prolonged pressure, often over bony areas like hips, heels, or tailbone, due to reduced blood flow, exacerbated by friction, shear, and moisture).This failure resulted in lack of daily wound treatment for:a. Resident 1's stoma (a surgically created opening in the body, usually on the abdomen, that connects an internal organ (like the bowel or urinary system) to the outside, allowing waste (urine or feces) to exit into a collection bag), left ischium (the curved bone forming the base of each half of the pelvis), perineal area (the diamond-shaped region of skin and muscle between the anus and the genitals, extending from the pubic bone to the tailbone), scrotum, and Sacro-coccyx (lower part of the spine and tail bone). b. Resident 2's prevention of wound injuryc. Resident 3's bilateral extremitiesd. Resident 5's left foot, left plantar, right heel, right ischium, right lateral foot stumpplacing the residents at risk for delayed wound healing and further skin breakdown.Findings: A review of Resident 1's admission Record indicated Resident 1 was admitted to the facility on [DATE] with diagnoses of quadriplegia (The complete inability to move due to sever disability frailty caused by another medical condition without physical injury or damage to the spinal cord), colostomy (a surgical procedure where a surgeon creates an opening in the abdominal wall so that stool can leave the body through he abdomen instead of the rectum) status, and open wound of left buttock. A review of Resident 1's Minimum Data Set (MDS- a resident assessment tool) dated 11/1/2025, indicated Resident 1 had intact cognition (the mental ability to think, remember and reason) for decisions of daily living, and required maximal assistance (Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) for eating. The MDS indicated Resident 1 was dependent (Helper does ALL of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity) on staff for toileting, lower body dressing, putting on/off footwear, and showering, rolling left and right, sit to lying, lying to sitting on side of bed, and transferring to the shower. The MDS indicated Resident 1 was at risk of developing pressure injuries (an injury that breaks down the skin and underlying tissue when an area of skin is placed under pressure). A review of Resident 1's Order Summary, dated 6/17/2025, indicated for Resident 1, to cleanse with normal saline (NS- a mixture of sodium chloride and water that is used to clean wounds), pat dry apply skin prep around stoma, apply colostomy bag everyday shift for colostomy management. Apply Santyl collagenase (is a prescription medication used to remove dead or damaged tissue from chronic skin ulcers and severe burns. This process helps promote the formation of healthy new tissue and wound healing) ointment to left ischium and perineal area to scrotum, topically every day for surgical wound for 30 days, cleanse with NS, apply collagen pellets, apply calcium alginate and cover with DD. Apply Zinc Oxide to Sacro-coccyx topically everyday shift for healed wound management. A review of Resident 2's admission Record indicated Resident 2 was admitted to the facility on [DATE] with diagnoses of dementia (progressive impaired ability to think, remember or make decisions that interferes with doing everyday activities) and difficulty in walking. A review of Resident 2's MDS, dated [DATE], indicated Resident 2 had moderate impaired cognition (ability to think, remember and reason) for decisions of daily living, and required supervision (Helper provides Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056206 If continuation sheet Page 4 of 6 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 056206 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE University Park Healthcare Center 230 E Adams Blvd Los Angeles, CA 90011 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently) for eating, partial assistance (Helper does LESS THAN HALF the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort) for oral hygiene, and maximal assistance for toileting, showering, upper and lower body dressing, putting on taking off footwear, personal hygiene, rolling left and right, sit to lying, lying to sitting on side of bed, and chair transfer. The MDS indicated Resident 2 was at risk of developing pressure injuries. A review of Resident 2's Order Summary, dated 6/4/2025, indicated to monitor functionality of low air loss mattress (LAL, a bed that alternates pressure to help heal and prevent pressure injuries) every shift for skin management. A review of Resident 3's admission Record, the admission Record indicated Resident 3 was admitted to the facility on [DATE] with diagnoses of contractures (the permanent tightening and shortening of muscles, tendons, skin, or other tissues around a joint, making it stiff, difficult to bend or straighten, and restricting normal movement, often caused by injury, nerve damage, inactivity, scarring ) to arms and ankle, and muscle weakness. A review of Resident 3's MDS, dated [DATE], indicated Resident 3 had intact cognition for daily decision making. The MDS indicated Resident 3 required set up assistance (Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity) for eating, oral hygiene, partial assistance (Helper does LESS THAN HALF the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort) for toileting, showering, upper body dressing, rolling left and right, sit to lying and lying to sitting on side of bed. The MDS indicated Resident 3 required maximal assistance (Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort) for putting on taking off footwear, lower body dressing and personal hygiene. The MDS indicated Resident 3 was at risk of developing pressure injuries. A review of Resident 3's Order Summary, dated 11/7/2024, indicated to apply A/D ointment to bilateral extremities and as barrier cream every shift for skin maintenance. A review of Resident 5's admission Record, indicated Resident 5 was admitted to the facility on [DATE] with diagnoses of pressure injury to left buttock and open wound left foot. A review of Resident 5's MDS, dated [DATE], indicated Resident 5 had severely impaired cognition for daily decision making. The MDS indicated Resident 5 was dependent on staff for oral hygiene, toileting, showering, upper and lower body dressing, putting on taking off footwear, personal hygiene, rolling left and right, sit to lying, lying to sitting on side of bed. The MDS indicated Resident 5 was at risk of developing pressure injuries. A review of Resident 5's Order Summary, dated 11/6/2025, indicated cleanse gastrostomy site with NS and apply dry dressing daily every shift. Apply Santyl ointment to left foot, left plantar, right heel, right ischium, right lateral foot stump, topically every day for 30 days. Monitor functionality of LAL mattress every shift for wound management A review of the Treatment Administration Record (TAR), dated 11/29/2025 and 12/1/2025, the TAR indicated physician-ordered daily wound care was not provided on scheduled days for Residents 1, 2, 3, and 5. During an interview on 12/15/2025 at 1:27 PM with the Treatment Nurse (TN), the TN stated he is the only full time TN at the facility, and was scheduled to work on 12/1/2025 but was unable to attend his shift. The TN verified treatments provided to residents on 11/29/2025 and 12/1/2025 on the electronic medical record and stated Residents 1, 2, 3, and 5 had not been provided treatment on those days per physician's order. The TN stated there was no documentation indicating treatment was completed, refused, or held. During an interview on 12/15/2025 at 1:58 PM with the Registered Nurse Supervisor (RNS), the RNS stated he worked on 12/1/2025 and was aware there was no assigned treatment nurse during the shift. The RNS stated he did not provide the ordered treatments, did not reassign another licensed nurse to complete (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056206 If continuation sheet Page 5 of 6 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 056206 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/15/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE University Park Healthcare Center 230 E Adams Blvd Los Angeles, CA 90011 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 0686 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete treatments, nor was informed of residents who didn't receive treatment. The RNS also verified that treatments for residents on 11/29/2025 was not provided by the treatment nurse assigned that day. The RNS stated the treatment nurse on 11/29/2025 did not report the missed treatments to anyone, including the physician. During an interview on 12/15/2025 at 2:15 PM with the Director of Nursing (DON), the DON stated the facility failed to assign a treatment nurse on 12/1/2025 which resulted in Residents 1, 2, 3, 4, and 5 not receiving treatment as ordered per physician. The DON stated she assigned herself to provide treatment on 12/1/2025 because she could not find anyone to provide treatment despite having licensed nurses in the facility that day. The DON stated she did not prioritize residents who required extensive treatment, or had more complicated wounds, hoping she could provide treatment to all residents with physician orders, but failed to complete treatments for at least five residents. The DON stated it is important to follow physician's orders to ensure residents are being provided with the necessary treatment and services to treat resident's diagnosis based on the clinical judgment of the ordering physician. The DON stated this failure placed residents at risk for deteriorating skin integrity. A review of the facility policy and procedures (P&P) titled Medication and Treatment Orders dated 7/2016, indicated, Medications and treatments shall be administered only upon the written order of a person licensed and authorized to prescribe such medications and treatments. A review of the facility P&P titled Pressure Ulcers/Skin Breakdown-Clinical protocol last reviewed 11/25/2025, indicated, Treatment Management -1. The physician will order wound treatments, including pressure reduction surfaces, wound cleansing and debridement approaches, dressings (occlusive, absorptive, etc) and application of tropical agents. Event ID: Facility ID: 056206 If continuation sheet Page 6 of 6