Health inspection·June 4, 2024

F 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to ensure the facility ' s licensed nursing staff met specific annual competencies to skill sets needed to care for a resident ' s respiratory care and services that included respiratory assessments and change in respiratory condition and skills when and how to provide interventions when appropriate for one of two sampled residents (Resident 1). This deficient practice had the potential for Resident 1 to experience a decline in respiratory condition and the potential to delay appropriate treatments and services. Finding: A review of Resident 1 ' s admission Record indicated the facility admitted the resident on [DATE] with diagnoses including acute respiratory failure (difficulty breathing on own) with hypoxia (low levels of oxygen in body tissues), atherosclerotic heart disease (hardening of the blood vessels), and heart failure. During a review of Resident 1 ' s Care Plan dated [DATE], indicated the resident was at risk for SOB with goal of resident not to have signs and symptoms of SOB or discomfort. The care plan Interventions indicated to assess alteration in sputum characteristic and effectiveness of treatment. Resident 1 ' s records did not indicate documented evidence for routine respiratory assessments performed by licensed nurses. A review of Resident 1 ' s History and Physical Dated [DATE], indicated Resident 1 did not have the capacity to understand and make decisions. A review of Resident 1 ' s Physician Orders for Life – Sustaining Treatment (POLST - a portable medical order form that records patients ' treatment wishes so that emergency personnel know what treatments the patient wants in the event of a medical emergency) prepared on [DATE], signed by the resident ' s power of attorney (POA) on [DATE], and signed and dated by Physician 1 on [DATE], indicated the medical interventions to be performed if the resident was found with no pulse and not breathing. The POLST indicated Do Not Attempt Cardiopulmonary Resuscitation (CPR - an emergency procedure used to restart a person's heartbeat and breathing after one or both have stopped) and to Allow Natural Death. The POLST further indicated under Medical Interventions, to provide the resident with Selective Treatment described as To treat medical condition while avoiding burdensome measures, that included in addition to treatment described in comfort- focused treatment, use of medical treatment, IV antibiotics, and IV fluids as indicated. The POLST further indicated Do not intubate, but May use non – invasive positive airway pressure (the delivery of oxygen into the lungs by face mask, nasal canula, ambu bag [device as a bag valve mask with is used to provide respiratory support to patients]), and generally avoid intensive care. The POLST indicated a handwritten statement indicated under Additional Orders of No Transfer. A review of Resident 1 ' s care plan for Alteration in Respiratory Function manifested by congestion dated [DATE] indicated the resident would have effective airway clearance daily for 90 days. The care plan indicated care plan interventions that included assessing the resident ' s respiratory status and alerting physician promptly, administering prescribed medications, and providing oxygen treatment as needed. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056317 If continuation sheet Page 2 of 9 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 056317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Haven Care Center 409 W. Glenoaks Blvd. Glendale, CA 91202 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few A review of Resident 1 ' s Order Summary for [DATE] indicated a physician order dated [DATE], indicating May titrate (a bedside measurement to evaluate a body ' s oxygen needs during exercise and at rest) oxygen at 2 to 5 Liters per minute by nasal canula (a thin, flexible tube that goes around the head and into the nose to deliver oxygen) to maintain oxygen saturation (amount of oxygen in the blood) of 92% and above. The physician order further indicated to notify the physician if oxygen saturation is less than (<) 92%, as needed for shortness of breath or oxygen saturation less than 92% via room air. Resident 1 ' s records did not indicate an order for continuous order of oxygen via nasal cannula (NC). A review of Resident 1 ' s Order Summary for [DATE] indicated a physician order dated [DATE] to perform oral suctioning as needed for secretion management. A review of Resident 1 ' s Order Summary for [DATE] indicated a physician order dated [DATE] with a start date of [DATE] to administer Ipratropium –Albuterol inhalation solution 0.5 - 2.5 (3) milligrams (mg-unit of measurement)/3 milliliter (ml), 1 vial inhale orally every six hours for pulmonary congestion (a condition in which the lungs fill with fluid causing shortness of breath) until [DATE]. A review of Resident 1 ' s Weights and Vitals Summary for [DATE], indicated Resident 1 ' s Oxygen Summary Saturation Summary. The Oxygen Summary indicated 36 entries that showed Resident 1 ' s oxygen saturations measured with oxygen via nasal cannula but did not indicate the amount of oxygen administered. -[DATE] at 1:07 AM, 95% (oxygen via NC) -[DATE] at 10:09 AM, 95% (oxygen via NC) -[DATE] at 12:41 AM, 96% (oxygen via NC) -[DATE] at 10:39 AM, 95% (oxygen via NC) -[DATE] at 12:37 AM, 95% (oxygen via NC) -[DATE] at 12:46 AM, 95% (oxygen via NC) -[DATE] at 11:00 AM, 95% (oxygen via NC) -[DATE] at 11:01 AM, 95% (oxygen via NC) -[DATE] at 8:45 AM, 97% (oxygen via NC) -[DATE] at 8:52 AM, 96% (oxygen via Mask) -[DATE] at 2:54 AM, 95% (oxygen via NC) -[DATE] at 11:23 AM, 95% (oxygen via NC) -[DATE] at 12:26 AM, 98% (oxygen via NC) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056317 If continuation sheet Page 3 of 9 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 056317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Haven Care Center 409 W. Glenoaks Blvd. Glendale, CA 91202 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 0726 -[DATE] at 9:36 AM, 95% (oxygen via NC) Level of Harm - Minimal harm or potential for actual harm -[DATE] at 9:42 AM, 95% (oxygen via NC) -[DATE] at 11:02 AM, 95% (oxygen via NC) Residents Affected - Few -[DATE] at 12:24 AM, 95% (oxygen via NC) -[DATE] at 10:04 AM, 96% (oxygen via NC) -[DATE] at 6:04 PM, 97% (oxygen via NC) -[DATE] at 1:20 AM, 99% (oxygen via NC) -[DATE] at 4:03 AM, 96% (oxygen via NC) -[DATE] at 10:10 AM, 97% (oxygen via NC) -[DATE] at 3:03 AM, 96% (oxygen via NC) -[DATE] at 1:31 AM, 96% (oxygen via NC) -[DATE] at 1:35 AM, 96% (oxygen via NC) -[DATE] at 12:33 PM, 95% (oxygen via NC) -[DATE] at 9:26 AM, 97% (oxygen via NC) -[DATE] at 4:20 AM, 96% (oxygen via NC) -[DATE] at 2:51 PM, 97% (oxygen via NC) -[DATE] at 2:32 AM, 96% (oxygen via NC) -[DATE] at 12:35 AM, 98% (oxygen via NC) -[DATE] at 1236 AM, 98% (oxygen via NC) -[DATE] at 12:35 PM, 95% (oxygen via NC) -[DATE] at 6:08 PM, 97% (oxygen via NC) -[DATE] at 8:08 PM, 97% (oxygen via NC) -[DATE] at 12:39 PM, 96% (oxygen via NC) A review of Resident 1 ' s Weights and Vitals Summary for [DATE], indicated Resident 1 ' s Oxygen Summary Saturation Summary. The Oxygen Summary indicated 49 entries that showed Resident 1 ' s oxygen saturations measured on room air. (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056317 If continuation sheet Page 4 of 9 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 056317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Haven Care Center 409 W. Glenoaks Blvd. Glendale, CA 91202 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 0726 -[DATE] at 1:07 AM, 96% (room air) Level of Harm - Minimal harm or potential for actual harm -[DATE] at 10:09 AM, 96% (room air) -[DATE] at 6:59 AM, 96% (room air) Residents Affected - Few -[DATE] at 10:38 AM, 97% (room air) -[DATE] at 11:00 PM, 97% (room air) -[DATE] at 3:48 AM, 96% (room air) -[DATE] at 12:39 PM, 97% (room air) -[DATE] at 623 PM, 97% (room air) -[DATE] at 1:54 PM, 97% (room air) -[DATE] at 3:23 AM, 97% (room air) -[DATE] at 10:36 AM, 96% (room air) -[DATE] at 4:28 AM, 97% (room air) -[DATE] at 9:46 AM, 98% (room air) -[DATE] at 1:53 PM, 98% (room air) -[DATE] at 11:22 AM, 97% (room air) -[DATE] at 10:11 PM, 97% (room air) -[DATE] at 7:23 PM, 96% (room air) -[DATE] at 6:00 AM, 97% (room air) -[DATE] at 11:02 AM, 97% (room air) -[DATE] at 1:28 AM, 97% (room air) -[DATE] at 1:30 AM, 97% (room air) -[DATE] at 12:24 AM, 97% (room air) -[DATE] at 9:54 AM, 96% (room air) -[DATE] at 10:11 AM, 97% (room air) -[DATE] at 3:05 AM, 96% (room air) (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056317 If continuation sheet Page 5 of 9 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 056317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Haven Care Center 409 W. Glenoaks Blvd. Glendale, CA 91202 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 0726 -[DATE] at 12:27 PM, 97% (room air) Level of Harm - Minimal harm or potential for actual harm -[DATE] at 10:32 AM, 97% (room air) -[DATE] at 10:33 AM, 97% (room air) Residents Affected - Few -[DATE] at 4:15 AM, 96% (room air) -[DATE] at 12:27 PM, 97% (room air) -[DATE] at 12:18 PM, 97% (room air) -[DATE] at 12:19 PM, 97% (room air) -[DATE] at 3:41 AM, 97% (room air) -[DATE] at 3:42 AM, 97% (room air) -[DATE] at 12:33 PM, 97% (room air) -[DATE] at 12:34 PM, 97% (room air) -[DATE] at 2:43 PM, 97% (room air) -[DATE] at 6:08 PM, 97% (room air) -[DATE] at 11:09 AM, 97% (room air) -[DATE] at 2:07 AM, 96% (room air) -[DATE] 2:08 AM, 96% (room air) -[DATE] 12:34 PM, 97% (room air) -5:24/24 at 9:50 AM, 97% (room air) -[DATE] at 9:51 AM, 97% (room air) -[DATE] at 12:57 AM, 97% (room air) -[DATE] at 12:59 AM, 97% (room air) -[DATE] at 7:10 PM, 97% (room air) -[DATE] at 4:39 AM, 98% (room air) -[DATE] at 1:38 PM, 97% (room air) During a telephone interview with the DON on [DATE] at 4:28 PM, the DON stated he could not find (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056317 If continuation sheet Page 6 of 9 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 056317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Haven Care Center 409 W. Glenoaks Blvd. Glendale, CA 91202 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 0726 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few documented evidence when Resident 1 ' s change in condition started since the documentation indicated Resident 1 was found pulseless, no respiration on [DATE]. The DON stated he could not find documented evidence if Resident 1was provided with oral suctioning and the resident ' s response to the respiratory treatments. The DON stated the resident ' s POLST also indicated may perform other selective treatments such as suctioning. The DON stated the license nurses should be listening to breath sounds and performing other respiratory assessments every shift. During a telephone interview on [DATE] at 5:41pm with LVN1, LVN 1 stated Resident 1 ' s need for oxygen was continuous requiring 2 liters of Oxygen by nasal cannula. LVN 1 stated Resident 1 would desaturate to 92% without the use of oxygen and might go as low as 90% with out its use. LVN 1 stated the day Resident 1 expired ([DATE]) the resident was on oxygen. LVN 1 stated Resident 1 was wheezing prior to oxygen treatment. LVN 1 stated he did not inform the physician anymore. LVN 1 stated she found Resident 1 deceased around 2 pm in the resident ' s room on [DATE]. During an interview on [DATE] at 1:21 pm with the DON, the DON stated the facility documents whether a resident was on oxygen or not in the Weights and Vitals Summary. The DON stated whenever he conducts facility rounds, the DON would always observe Resident 1 using oxygen by nasal cannula. When asked why Weights and Vitals Summary record indicated Resident 1 was on room air at times, the DON stated the Weights and Vital Summary record indicated by what method the LVN checked oxygenation (off or on oxygen) not whether the resident is using oxygen. The DON stated because the physician ordered oxygen as needed (PRN) it was acceptable to check oxygen saturation on room air even if Resident 1 was currently requiring oxygen by nasal canula. During an interview on [DATE] at 6:00 pm, the DON stated he had only provided competency check off for two facility licensed staff members. The DON stated one Registered Nurse and one Licensed Vocational Nurse. The DON stated he had checked on the facility staff ' s records and could not locate any past employee competencies. During an interview on [DATE] at 10 am with Resident 1 ' s attending physician (Physician 1), Physician 1 stated Resident 1 required continuous oxygen by nasal cannula. Physician 1 stated he did not know why the oxygen was not ordered as continuous in the physician ' s orders. Physician 1 stated that Resident 1 ' s family (Family 1) requested comfort measures only. Physician 1 stated he thought he documented the discussion with Family 1 in the resident ' s records. A review of the facility ' s policy and procedure titled, Oxygen Administration Policy No – NP- 243 Revised on [DATE], indicated documentation to be included in medical chart shall include date and time oxygen is being used, oxygen flow rate and device being used. Findings of physical assessment such as skin color, breathing pattern, effort of breathing, rate, depth, and oxygen saturation to be included. A review of the Facility ' s policy and procedure titled, Pulse Oximetry Policy No – NP -246 Revised on [DATE], indicated the process the Licensed Nurse would follow in the use of pulse oximetry . The policy did not indicate the removal of oxygen prior to obtaining oxygenation status. During an interview on [DATE], the DON stated it is a standard of practice and a staffing requirement to have competent nurses. The DON stated the nurse ' s competency gets evaluated upon hire and as part of their evaluation on annual bases. The DON stated he could not find a facility policy for annual staff competencies. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056317 If continuation sheet Page 7 of 9 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 056317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Haven Care Center 409 W. Glenoaks Blvd. Glendale, CA 91202 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 0842 Level of Harm - Minimal harm or potential for actual harm Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. Based on observation, interview, and record review the facility failed to document that one of two sampled residents (Resident 1) were provided respiratory treatment and services in the resident ' s medical records. Residents Affected - Few This deficient practice had the potential for serious negative consequences of patient care and overall compliance with the facility ' s policy with potential to result in medical records containing inaccurate documentation. Findings: A review of Resident 1 ' s admission Record indicated the facility admitted the resident on 2/14/2024 with diagnoses including acute respiratory failure (difficulty breathing on own) with hypoxia (low levels of oxygen in body tissues), atherosclerotic heart disease (hardening of the blood vessels), and heart failure. During a review of Resident 1 ' s Care Plan dated 2/14/2024, indicated the resident was at risk for SOB with goal of resident not to have signs and symptoms of SOB or discomfort. The care plan Interventions indicated to assess alteration in sputum characteristic and effectiveness of treatment. Resident 1 ' s records did not indicate documented evidence for routine respiratory assessments and post assessments after breathing treatments were performed by licensed nurses. A review of Resident 1 ' s History and Physical Dated 2/15/2024, indicated Resident 1 did not have the capacity to understand and make decisions. A review of Resident 1 ' s care plan for Alteration in Respiratory Function manifested by congestion dated 4/10/24 indicated the resident would have effective airway clearance daily for 90 days. The care plan indicated care plan interventions that included assessing the resident ' s respiratory status and alerting physician promptly, administering prescribed medications, and providing oxygen treatment as needed. A review of Resident 1 ' s Progress Notes entry dated: 5/26/2024 timed at 2:20 PM, authored by LVN 1, (7am – 3pm shift) indicated Resident [1] pulseless without respirations. [Physician 1] notified. Resident POA notified [sic]. POA explained she will call back later to give the name of crematory. A review of the next entry on Resident 1 ' s Progress Notes dated 5/26/2024 timed at 4:10 PM, authored by LVN 2 (7am – 3pm shift), indicated [Resident 1] POA here but refused to give crematory name. A review of the following entries made in Resident 1 ' s Progress Notes indicated the following information: -On 5/26/2024 timed at 7:23 PM, authored by Registered Nurse (RN) 1, indicated Crematory here to pick up resident body [sic]. -On 5/26/2024 timed at 8:54 PM, authored by LVN 3 (3pm – 11pm shift), indicated Body picked (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056317 If continuation sheet Page 8 of 9 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 056317 B. Wing A. Building (X3) DATE SURVEY COMPLETED 06/04/2024 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Golden Haven Care Center 409 W. Glenoaks Blvd. Glendale, CA 91202 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 0842 up at [7:40 PM] by mortuary. Level of Harm - Minimal harm or potential for actual harm A review of Resident 1 ' s Care conference interdisciplinary team meeting (IDT) dated 2/20/2024, did not indicate Resident 1 ' s condition was discussed with the resident ' s family member and Power of Attorney (POA) and in agreement for Resident 1 to be placed on comfort care or palliative care (end of life care) this care focuses on providing comfort, symptom management, nearing the end of life. Residents Affected - Few A review of Resident 1 ' s Care plans indicated no documented evidence that a care plan for comfort care had been created to ensure that the residents needs were met, and their comfort is prioritized. The care plan should outline the specific interventions and strategies that will be implemented to provide comfort and support to the resident. A review of Resident 1 ' s physician progress notes indicated Resident 1 ' s plan of care had been reviewed, and treatment goals, expected outcomes and prognosis were established with care coordinated to staff and providers. There was no documentation or evidence of indicated discussion in the IDT meeting notes or resident care plans. During a concurrent interview and record review on 5/31/24 at 4:28 pm, Resident 1 ' s Nursing notes dated 5/26/2024 at 2:20 pm was reviewed with the DON. The DON stated RN 1 ' s documentation of Resident 1 being pulseless without respiration, performing vital signs and informing the physician. The DON verified no evidence of documentation for RN1 informing the physician and performing vital signs could be found under RN1 ' s electronic signature in the facility ' s electronic records. The DON stated he could not find documented evidence when Resident 1 ' s change in condition started since the documentation indicated Resident 1 was found pulseless, no respiration on 5/26/24. The DON stated he could not find documented evidence if Resident 1was provided with oral suctioning and the resident ' s response to the respiratory treatments. The DON stated the resident ' s POLST also indicated may perform other selective treatments such as suctioning. The DON stated the license nurses should be listening to breath sounds and performing other respiratory assessments every shift. During a telephone interview on 6/4/2024 at 10 am with Resident 1 ' s attending physician (Physician 1), Physician 1 stated he documented in March progress notes, that Resident 1 ' s family (POA) requested comfort measures only. Physician 1 stated he thought he documented the discussion with Family 1 in the resident ' s records. There was no documented evidence found for this discussion in the physician progress notes and Resident ' 1s IDT records. During a telephone interview on 6/4/24 at 10 am, RN1 stated she was not able to access the facility ' s electronic charting using the password the facility had provided to RN 1. RN 1 stated she asked LVN1 for her electronic password to document in the electronic chart. RN 1 stated that is why Resident 1 ' s electronic records under the nursing entry did not indicate it was RN 1 who documented the nursing progress notes of Resident 1 ' s condition on 5/26/24. A review of the facility ' s policy and procedure titled, Documentation Policy No. – Np – 105 with revision date of 6/1/2017, indicated its purpose was to provide documentation of resident status and care given by nursing staff. Policy indicated Nursing documentation will be concise, clear, pertinent, and accurate. Nursing staff will not falsify or improperly correct nursing documentation. FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056317 If continuation sheet Page 9 of 9