Health inspection·November 23, 2025

F 0605 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few experiencing a cardiac arrest (when the heart suddenly and unexpectedly stops beating) on 11/1/2025, transfer to a General Acute Care Hospital (GACH) 2 where Resident 2 was intubated (having a breathing tube inserted through the mouth or nose into the windpipe to maintain an open airway and assist breathing, often through a mechanical ventilator [a medical treatment using a machine to support or take over a patient's breathing]) and admitted to the intensive care unit ([ICU] a hospital department that provides constant, specialized medical care to critically ill patients with life-threatening conditions). On 11/3/2025 Resident 2 experienced an acute hypoxic hypercapnic respiratory failure (a life-threatening condition where the body has both too little O2 and too much carbon dioxide [a colorless odorless gas] in the blood) and died later the same day. On 11/21/2025 at 5:45 p.m., an Immediate Jeopardy ([IJ] a situation in which the facility's noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident) was called in the presence of the facility's Administrator (ADM) and Director of Nursing (DON) due to the facility's failure to recognize the increased effect of the concurrent administration of sedative, anti-anxiety, psychotropic, and narcotic- analgesic medication, leading to Resident 2's oversedation, CNS depression and subsequent respiratory arrest (when a person stops breathing or their breathing becomes too weak to sustain life). These deficient practices placed 31 other residents, who were receiving narcotics and psychotropic medications, at increased risk for oversedation, CNS depression, respiratory failure and cardiac arrest. On 9/10/2025, the facility submitted an acceptable IJ Removal Plan ([IJRP] interventions to immediately correct the deficient practices). After onsite verification of the facility's IJRP's implementation through observation, interview, and record review, the IJ was removed on 9/10/2025 at 3:40 p.m., in the presence of the facility's DON and ADM.On 11/23/2025, the facility submitted an acceptable IJ Removal Plan ([IJRP] intervention to immediately correct the deficient practice) after onsite verification of the IJRP's implementation through observation, interview, and record review, the IJ was removed on 11/23/2025 at 12:54 p.m., in the presence of the facility's ADM and DON. The facility's IJRP included the following immediate actions: 1. On 11/2220/25, the DON provided 1:1 training with LVN 1 on the following. 2. Drug interactions between narcotics (a substance used to treat moderate to severe pain by binding to opioid receptors in the central nervous system) and benzodiazepines drugs. 3. Indication for use of narcotic medications, side effects, drug interactions, dosage and black box warnings (the strongest warning issued by the U.S. Food and Drug Administration for a prescription drug, indicating there is a reasonable association between the drug and a serious hazard that may result in death or serious injury). 4. The location of the medication information (Drug Reference Handbook). 5. Initiating a change of condition (COC) and notification to the physician for any medication adverse effects or signs and symptoms of opioid overdose. HOW TO IDENTIFY OTHER RESIDENTS: On 11/21/2025 and 11/22/2025, DON and ADON reviewed current residents with orders for narcotic medications. There were 50 residents with narcotic orders. The DON and/or ADON will obtain an order for the 50 residents with narcotic orders to monitor or s/s of and side effects every shift and to document in the Medication Administration Record (MAR). On 11/22/2025, the facility's Pharmacy Consultant conducted a medication review of residents with orders for narcotics, benzodiazepine, and psychotropic (used to treat mental disorders including antidepressants, antipsychotics sedative, anti-anxiety and narcotics) medications for possible drug interactions. There were 31 residents with orders for both narcotics and benzodiazepines/psychotropic medications. The Pharmacist Consultant's recommendations will be communicated to the physician and orders will be carried out by 11/22/25. On 11/22/2025, the Clinical team which includes the DON, ADON, Quality Assurance (QA) Nurse, Nursing Supervisor, and Licensed Nurses reviewed 31 residents with (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056234 If continuation sheet Page 2 of 8 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 056234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marlora Post Acute Rehab Hosp 3801 E Anaheim St Long Beach, CA 90804 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 0605 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few orders for narcotic, benzodiazepines and psychotropic drugs for s/s of drug overdose. SYSTEMIC CHANGES: On 11/21/2025 and 11/22/2025, the DON and DSD conducted an in-service training with licensed nurses on the following topics: 1. Drug interactions between benzodiazepines, sedative, anti-anxiety and psychotropic drugs. 3. Indication of narcotic medications, side effects, drug interactions, dosage and black box warnings. 4. The location of the medication information (Drug Reference Handbook). 5. Initiating COC and notification to the physician for any medication adverse effects or signs and symptoms of oversedation and/or CNS depression due to concurrent administration of narcotic-analgesics, sedatives, anti-anxiety and psychotropics. On 11/22/2025, Pharmacy Consultant conducted an in-service with the licensed nurses on the possible drug interaction of medications when given together such as benzodiazepine, and psychotropic medications. The remaining licensed nurses will be provided in-service by the DON/Designee on the first day of returning to work. On 11/22/2025 the Quality Assurance Committee met with the Medical Director, ADM, Pharmacy Consultant, DON, DSD, ADON, and QA Consultant to discuss the deficient practices identified and the corrective action to prevent re-occurrence of the deficient practices. On 11/21/2025 and 11/22/2025, the DSD and the QA Nurse Consultants initiated the knowledge competencies with licensed nurses on the following: 1. The location of the medication's information (Drug Reference Handbook). 2. Initiating COC and notification to the physician for any medication adverse effects or signs and symptoms of opioid overdose. The DSD and/or DON will continue to provide in-service training and complete knowledge competencies until all licensed nurses have gone through the training and competencies by 11/24/2025. The In-service and knowledge competencies will be completed by the licensed nurses on leave on their first day of returning to work. The DSD will incorporate the knowledge competency with the licensed nurses' orientation program; this will be completed during the new hire orientation then annually and as needed. The DSD and the DON will provide quarterly in-services with the licensed nurses on the following: 1. The location of the medication's information (Drug Reference Handbook). 2. Initiating COC and notification to the physician for any medication adverse effects or signs and symptoms of opioid overdose. MONITORING PROCESS: The DON will track any trends or concerns related to side effects, and drug interactions identification; this will be communicated to the QA & A Committee for further evaluation and recommendations monthly. If it is determined that we have accomplished the objectives in the POC (plan of correction) above and the results are successful, then the facility will consider the matter resolved. The QA & A committee will continue to review until such time that the deficiency has been proven to be resolved for three consecutive months and/or advised by the QA & A Committee.Findings: During a review of Resident 2's admission Record (Face Sheet), the Face Sheet indicated Resident 2 was originally admitted to the facility on [DATE], and readmitted on [DATE] with diagnoses including CHF, COPD, chronic respiratory failure, and dependence on supplemental O2. During a review of Resident 2's Minimum Data Set ([MDS] a resident assessment tool) dated 8/21/2025, the MDS indicated Resident 2 had moderate cognitive impairment (the ability to think and reason). During a review of Resident 2's Progress Note dated 10/19/2025, the Progress Note indicated Resident 2 had an unwitnessed fall at 10:30 p.m., 911 was called, and paramedics transported Resident 2 to a General Acute Care Hospital (GACH) 1 at 11:05 p.m. During a review of Resident 2's Paramedic Incident Report dated 10/19/2025, the Paramedic Incident Report indicated Resident 2 had shortness of breath (SOB) for one hour and his lung sounds revealed rhonchi (a continuous, low-pitched, rattling lung sounds that often resemble snoring or gurgling caused by airflow obstruction). The Paramedic Incident Report indicated Resident 2 was transported to a GACH 1 emergency department, where he was until 10/31/2025. During a review of the GACH 1's Plan and Goals for admission dated 10/31/2025, the Plan and Goals for admission indicated, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056234 If continuation sheet Page 3 of 8 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 056234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marlora Post Acute Rehab Hosp 3801 E Anaheim St Long Beach, CA 90804 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 0605 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Physician (MD) 2, a pulmonary specialist (a physician specializing in the respiratory system, including the lungs, airways, and blood vessels), recommended to decrease Resident 2's sedative medications (a class of medications that slows down the central nervous system to relieve anxiety or induce sleep) polypharmacy (the simultaneous use of multiple drugs to treat a single ailment or condition) as it was likely the culprit (the cause of a problem) of Resident 2's recurrent respiratory failure. During a review of Resident 2's Physician's Order dated 10/31/2025, the Physician's Order indicated to readmit Resident 2 to the facility. During a review of Resident 2's Physician's Order dated 10/31/2025, the Physician's Order indicated the following orders: 1. Buspirone HCL oral tablet 10 mg twice a day for anxiety manifested by verbalizing persistent worry regarding his health and living circumstance. 2. Monitor the black box warning for Buspirone HCL that indicated concomitant (occurring at the same time) use of benzodiazepines and narcotics may result in profound sedation, respiratory depression, coma, and death. The black box warning indicated to reserve concomitant prescribing of these drugs for use in patients whom alternative treatment options are inadequate, to limit dosages and durations to the minimum required, and to follow patients for signs and symptoms (s/s) of respiratory depression and sedation every shift. 3. Diazepam 7.5 - milligram ([mg] a unit of dose measurement) three times a day for anxiety. 4. Norco 7.5 mg/325 mg every six hours as needed for moderate to severe pain. 5. Olanzapine 10 mg twice a day for a psychotic disorder (a serious mental illness characterized by a loss of contact with reality) related to a panic disorder (an anxiety disorder characterized by recurrent, unexpected panic attacks [sudden episodes of intense fear accompanied by physical symptoms like a pounding heart, sweating, and dizziness]). 6. Olanzapine 15 mg at bedtime for a psychotic disorder. 7. Administer O2 at three liters ([L] a unit of measurement) per minute via a nasal cannula (a medical device that delivers supplemental O2 through a lightweight tube with two prongs that rest in the nostrils) at all times. During a review of Resident 2's Medication Administration Audit Report (MAAR) dated 11/2025, the MAAR indicated the following medication was administered to Resident 2 on 11/1/2025: 1. LVN 1 administered Norco 7.5 mg-325 mg to Resident 2 at 8:30 a.m. 2. LVN 1 administered Buspirone HCL 10 mg to Resident 2 at 8:50 a.m. 3. LVN 1 administered Diazepam 7.5 mg to Resident 2 at 8:50 a.m. 4. LVN 1 administered Olanzapine 10 mg to Resident 2 at 8:50 a.m. During a review of Resident 2's Progress Note dated 11/1/2025, the Progress Note indicated at 9:07 a.m., Certified Nursing Assistant (CNA) 1 made LVN 1 aware that Resident 2 was unresponsive. The Progress Note indicated upon entering Resident 2's room, LVN 1 noted Resident 2 was sitting up in bed, unresponsive to verbal commands, diaphoretic (profuse sweating), and still breathing. The Progress Note indicated a code blue (signifies a patient requires immediate resuscitation, most often due to cardiac or respiratory arrest) was called but before the crash cart (a wheeled container carrying medicine and equipment for use in emergency resuscitations) arrived, Resident 2 stopped breathing. The Progress Note indicated Cardiopulmonary resuscitation ([CPR] an emergency treatment that's done when someone's breathing or heartbeat has stopped) began at 9:09 a.m., 911 was called, and CPR continued until 9:20 a.m., until paramedics arrived and took over CPR. The Progress Note indicated Resident 2's pulse returned, and he was transferred to a GACH 2 at 9:27 a.m. During a review of Resident 2's Paramedic Incident Report dated 11/1/2025, the Paramedic Incident Report indicated paramedics arrived to the facility at 9:13 a.m., and were informed that Resident 2 received Norco 7.5 mg/325 mg at 8:30 a.m. The Paramedic Incident Report indicated upon arrival Resident 2 had altered level of conciseness (ALOC) with pinpoint pupils (abnormally constricted pupils that could be caused by opioid use, other medications, brain injuries, certain infections, or other medical conditions) and his Glascow Coma Scale ([GCS] a neurological assessment tool used to rate a person's level of consciousness based on (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056234 If continuation sheet Page 4 of 8 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 056234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marlora Post Acute Rehab Hosp 3801 E Anaheim St Long Beach, CA 90804 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 0605 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few their eye opening, verbal, and motor responses) was 3 (normal score being 15, and 3 being the lowest possible score indicating a coma). The Paramedic Incident Report indicated paramedics administered one dose of Narcan 2 mg via inhalation at 9:31 a.m., while enroute to the GACH but it did not yield positive result and Resident 2 remained with ALOC. The Paramedic Incident Report did not indicate the nursing staff informed the paramedics of the other medications Resident 2 received. During a review of the GACH's Emergency Department (ED) record dated 11/1/2025 and timed at 9:39 a.m., the ED record indicated upon arrival to the ED Resident 2 had agonal respirations (gasping, shallow, irregular breaths that occur when the brainstem is trying to compensate for a lack of O2) at six breaths per minute (normal respiration 12 to 20 breaths per minute for a healthy adult). The ED record indicated in the field, Resident 2 presented with pinpoint pupils and received Narcan with no change in level of consciousness. The ED record indicated Resident 2 was intubated shortly after arrival for airway protection. During a review of the GACH's Discharge summary dated [DATE], the Discharge Summary indicated Resident 2 was brought to the ED and was intubated due to acute hypoxic hypercapnic respiratory failure (a life-threatening condition where the body has both too little oxygen and too much carbon dioxide [a naturally occurring, colorless, odorless gas] in the blood). During a review of the GACH Discharge summary dated [DATE], the Discharge Summary indicated on 11/3/2025 Resident 2 was admitted to the ICU where a bronchoscopy (a medical procedure where a thin, flexible tube called a bronchoscope is inserted through the nose or mouth to examine the airways and lungs) was done. The bronchoscopy showed Resident 2's left side mainstem bronchus (one out of the two large airway branches that carry air to the lungs) was completely blocked by mucus (a slimy substance secreted by mucous membranes and glands for lubrication and protection). The GACH Discharge Summary indicated Resident 2 was extubated (to remove a tube of artificial ventilation) on 11/1/2025 and transferred to the ward (a lower level of care due to a stable condition). The GACH 2's Discharge Summary indicated on 11/3/2025 in the a.m. (time unknown) Resident 2 had hypoxic hypercapnic respiratory failure but improved with aggressive suctioning (a procedure that uses negative pressure to remove bodily fluids, gases, or secretions to maintain a clear airway) and was transferred to the telemetry unit (a hospital floor where patients are continuously monitored for cardiac and vital signs). The GACH 2's Discharge Summary indicated on 11/3/2025, at 5:16 p.m., Resident 2 became more somnolent (sleepy and drowsy) with labored (done with great effort and difficulty) breathing that was not improving with aggressive suctioning, and Resident 2 presented without a gag reflex (an involuntary, protective reflex triggered by touching the back of the throat, which causes the throat muscles to contract and the soft palate to lift) and hypercapnic respiratory failure (when the lungs cannot remove enough carbon dioxide from the blood, causing it to build up). The GACH 2's Discharge Summary indicated comfort measures (a type of care focused on relieving pain and other symptoms, rather than curing an illness) were pursued at 5:43 p.m., and Resident 2 was pronounced dead at 7:20 p.m. During an interview on 11/19/2025 at 9:17 a.m., LVN 1 stated she gave Resident 2 Norco 7.5 mg/325 mg at approximately 8:30 a.m., and at approximately 9 a.m., she gave him Diazepam, Buspirone HCL, Olanzapine. LVN 1 stated at that time Resident was awake, alert, and oriented. LVN 1 stated at 9:05 a.m. to 9:10 a.m., CNA 1 stood outside Resident 2's doorway and reported to her that something was wrong with Resident 2. LVN 1 stated when she went into Resident 2's room he was sitting up in bed and was observed with shortness of breath (SOB). LVN 1 stated Resident 2 was unresponsive to verbal stimuli (a word phrase, or other language pattern [spoken, written, or signed] that acts as a trigger or cue) and was leaning forward trying to catch his breath. LVN 1 stated she called a code blue due to Resident 2's unresponsiveness, but he still had a pulse at that time. LVN 1 stated one minute later, after the code blue was called, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056234 If continuation sheet Page 5 of 8 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 056234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marlora Post Acute Rehab Hosp 3801 E Anaheim St Long Beach, CA 90804 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 0605 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few Resident 2 was no longer breathing and had no pulse. LAN 1 stated she flattened his bed, placed a board under him, and Registered Nurse (RN) 1 began compressions (the manual pushing of a person's chest to simulate a heartbeat, helping to pump blood and oxygen throughout the body). LVN 2 stated someone from the team (unknown) called 911 and CPR continued until paramedics arrived. Paramedics took over CPR and transferred Resident 2 to GACH 2. During an interview on 11/20/2025 at 1:08 p.m., LVN 1 stated she did not recall what Olanzapine was indicated for when she administered it to Resident 2 at 9 a.m., with Diazepam, Buspirone and Norco medications on 11/1/2025. LVN 1 stated the side effects of Norco and Diazepam could cause drowsiness or depression of respirations. LVN 1 stated she was not aware of the interactions between Diazepam, Norco, and Buspirone, but stated she followed the physician's orders. LVN 1 stated she was not familiar with the black box warning for Buspirone, and she monitors side effects, but does so toward the end of her shift. During an interview on 11/19/2025 at 9:36 a.m., the facility's Pharmacy Consultant (PC) stated the combination of Norco 7.5 mg/325 mg and Diazepam 7.5 mg that Resident 2 received, had a high risk for oversedation and respiratory failure due to CNS depression since the combination had a synergistic (a term to describe an interaction between two or more drugs where their combined effect is greater than the sum of their individual effects) effect to it. The PC stated Buspirone HCL, narcotics, Buspirone HCL and benzodiazepines, or all three combined, could contribute to CNS depression resulting in respiratory failure. The PC stated the combination of Norco, Diazepam, and Olanzapine could also synergistically and consequently cause a drug overdose, presenting as altered mental status (AMS), comatose, unresponsiveness, labored breathing and/or low breaths per minute. The PC stated ideally, when LVN 1 administered Norco to Resident 2, she should have conducted a follow up assessment thirty minutes to an hour later and prior to giving any other medications to determine whether it was safe to give other medications to Resident 2. The PC stated, since Diazepam and Olanzapine were new medications prescribed to Resident 2, and not something they routinely gave to Resident 2 at the facility; there should have been extra precautions and monitoring taken. The PC stated knowing Resident 2's history and tolerance of medications prior to administering a combination like Diazepam and Norco was important, but as a pharmacist he would not recommend to give these medications concurrently due to the high risk of oversedation and CNS depression. The PC stated pinpoint pupils were a cholinergic (parasympathetic nervous system [part of the nervous system that controls involuntary body functions when at rest, such as digestion, heart rate, and breathing response which decreases the heart rate, increases pupil constriction, and increased digestion and urination]) response from narcotic, oversedation, labored breathing, and respiratory distress (the difficulty or inability to breathe, characterized by symptoms like SOB, rapid or noisy breathing, and sweating). The PC stated Resident 2 had a history of COPD so if he had respiratory depression and was intubated, his recovery would be more difficult because he was elderly and did not have the strength. The PC stated staff should have reported to the paramedics that Resident 2 received benzodiazepines concurrently with narcotic-analgesic because flumazenil ([Romazicon] an intravenous [IV] in the vein] medication that acts as a specific antidote [drugs used to counteract or neutralize the effects of another substance, such as an anesthetic, narcotic, poison, or toxin] to reverse the sedative effects of benzodiazepines) could have been administered to Resident 2 to act as a reverse agent. During an interview on 10/19/2025 at 10:38 a.m., Resident 2's physician stated he did not recall if he ordered Olanzapine or Diazepam for Resident 2, but any new psychiatric and/or psychotropic medications prescribed for Resident 2 was likely transcribed from the GACH 1's discharge summary because 93% of the time he does not prescribe psychiatric medications. Resident 2's physician stated Resident 2 displayed a lot of anxiety and was being seen by a psychiatrist. Resident (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056234 If continuation sheet Page 6 of 8 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 056234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marlora Post Acute Rehab Hosp 3801 E Anaheim St Long Beach, CA 90804 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 0605 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few 2's physician stated s/s of suspected oversedation included not responding to stimuli (verbal, physical [light, sound, touch, pain, temperature, smells, tastes, irritants]), a slow respiratory rate less than 5-10 breaths per minute, and constricted pupils (pinpoint pupils). Resident 2's physician stated pinpoint pupils, and decreased response would go along with the sedatives/narcotics mix, and that combination of medications could cause decreased responsiveness and decreased respiratory rate. Resident 2's physician stated he was aware that Resident 2 was transferred to GACH 2 on 11/1/2025 but stated he did not know the details of what happened to Resident 2. During an interview on 11/19/2025 at 11:18 a.m., the DON stated Resident 2 was not taking Diazepam or Olanzapine prior to his hospitalization on 10/19/2025. The DON stated if she was not familiar with a drug or how it interacted with other medications, she would look it up to avoid possible reactions, and/or clarify the order with physician. The DON stated side effects of narcotics and benzodiazepines both include depression of respirations, AMS/ALOC and confusion. The DON stated she would be cautious giving Resident 2 Norco and Diazepam concurrently and would check the resident's respirations since both medications were CNS depressants. The DON stated Buspirone HCL, narcotics and/or benzodiazepines combined could place Resident 2 at an increased risk for CNS depression. The DON stated there was a black box warning for Buspirone HCL on Resident 2's Medication Administration Record (MAR), but it was not signed off by LVN 1 to acknowledge that she read it prior to administering the medications to Resident 2. During an interview on 11/19/2025 at 12:39 p.m., with the DSD, the DSD stated she was responsible for training staff in medication administration but stated in the past one year and six months to two years that she had worked at the facility, she had not trained staff on black box warnings, or use of narcotics concurrently with psychotropic medications. The DSD stated if licensed nurses were not familiar with a drug, they should call the doctor or pharmacist. During an interview on 11/21/2025 at 9:48 a.m., the psychiatric Nurse Practitioner (NP) stated Diazepam 7.5 mg was a large dose and he was not aware that Resident 2 was prescribed Diazepam or Olanzapine. The NP stated Resident 2 received Buspirone and Norco together without issues in the past because his tolerance of the medications was high. The NP stated the combination of Olanzapine, narcotic-analgesic, and Diazepam could have a sedative effect, and the narcotic pain medication and benzodiazepine should be spaced out at least one hour from each other and not given concurrently. The NP stated if he would have known Resident 2 was prescribed Olanzapine, he would have adjusted the dose because 10 mg twice a day and 15 mg at night was a lot. The NP stated, he would have clarified the indication for Olanzapine's use because Resident 2 did not have a diagnosis to support the prescription of that medication. The NP stated he would have also adjusted the dose of the Diazepam to be lower, because Norco and Diazepam were both CNS depressants. During a review of the National Library of Medicine's drug information on hydrocodone bitartrate and acetaminophen usage warning, revised on 10/6/2025, the National Library of Medicine's drug information indicated concomitant use of narcotics with benzodiazepines or other central nervous system depressants such as antipsychotics may result in profound sedation, respiratory depression, coma, and death. The National Library of Medicine's drug information warning indicated serious, life-threatening, or fatal respiratory depression has been reported with the use of narcotics, even when used as recommended and that respiratory depression, if not immediately recognized and treated, may lead to respiratory arrest and death. The National Library of Medicine's drug information indicated management of respiratory depression may include close observation, supportive measures, and use of narcotics antagonists (a substance which interferes with or inhibits the physiological action of another substance), depending on the patient's clinical status. The National Library of Medicine's drug information indicated narcotics can cause sleep-related breathing disorders including central sleep (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056234 If continuation sheet Page 7 of 8 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 056234 B. Wing A. Building (X3) DATE SURVEY COMPLETED 11/23/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Marlora Post Acute Rehab Hosp 3801 E Anaheim St Long Beach, CA 90804 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 0605 Level of Harm - Immediate jeopardy to resident health or safety Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete apnea (CSA, a sleep disorder where the brain temporarily fails to send signals to the muscles that control breathing, causing repeated pauses in breathing during sleep) and sleep-related hypoxemia. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl. During review of facility's P/P titled Administering Medications dated 1/2024, the P/P indicated If a dosage is believed to be inappropriate for a resident, or a medication has been identified as having potential adverse consequences (a negative or harmful result) for the resident or is suspected of being associated with adverse consequences, the person preparing or administering the medications will contact the prescriber, attending physical, or facility medical director to discuss concerns. Event ID: Facility ID: 056234 If continuation sheet Page 8 of 8