Health inspection·February 18, 2026

F 0580 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few dated 2/9/2026, the OSR indicated Resident 1 may have LAL mattress for wound and skin management based on resident's weight, comfort and hand test, every day shift. The order indicated it was discontinued due to skin being intact. During a review of Resident 1's Social Service (SS) Note, dated 2/11/2026 at 12:14 p.m., the SS Note indicated Social Services Director (SSD) receive a note from Resident 1 Family Member (FM1) complaining regarding the mattress that was taken away or removed from Resident 1. The SSD spoke with treatment nurse and he explained to FM1 that Resident 1 did not need it. FM1 asked an order from the doctor but the Treatment nurse said it is not necessary to receive an order from the doctor, as Resident 1 did not have wounds. FM1 said that if they do not re-install the LAL mattress, they will have to re-position Resident 1 every two (2) hours. The SSD will follow up with the Director of Nursing (DON) and give an answer to FM1. During a review of Resident 1's OSR dated 2/12/2026 the OSR indicated may have LAL mattress for wound and skin management based on resident's weight, comfort and hand test, every day shift. During an interview on 2/18/2026 at 1 p.m. with the SSD, the SSD stated on 2/10/2026 FM 1 came in and gave grievance to SSD regarding Resident 1's LAL mattress being removed. The SSD stated spoke to Treatment Nurse (TN) 1, and TN 1 stated Resident 1 no longer had wound and did not need the LAL mattress and FM 1 asked if there was an order to remove LAL, TN 1 stated no order was needed to remove the LAL mattress. The SSD stated FM 1 stated if Resident 1 did not have the LAL mattress Resident 1 would need to be repositioned every two hours. The SSD stated spoke to the Administrator (Adm) and was told they would give Resident 1 an LAL mattress for preventative measures. During an interview on 2/18/2026 at 2:10 p.m. with TN 1, TN 1 stated Resident 1 used to have a pressure ulcer a year ago but was resolved. TN 1 stated Resident 1 was on a LAL mattress for a long time as preventative measure. TN 1 stated the LAL mattress was removed for Resident 1 about a week ago because the Director of Nursing (DON) told TN 1 to discontinue for residents who did not have a pressure ulcer but then Resident 1's family came in and requested to have the LAL mattress again and we did implement the LAL mattress at that time. TN 1 stated did not notify the doctor or the family because it is a protocol we have that we implement based on any skin issues and there was no need for an order. TN 1 stated did not notify the doctor when facility implemented it (LAL mattress) again as there was no actual Change in Condition (COC) for Resident 1 needing the doctor to be notified.During a concurrent interview and record review on 2/18/2026 at 3:34 p.m. of Resident 1's Braden Scale for Predicting Pressure Ulcer Risk Evaluation, dated 1/8/2026, was reviewed with the DON. The DON stated that even if Resident 1 did not have pressure ulcer at this time based on assessment Resident 1 needed the LAL mattress. The DON stated that for the use of LAL it needed an order and needed an order to discontinue it as well. The DON stated if TN 1 stated he did not notify the doctor, then there was an issue with that. The DON stated TN 1 should have notified the doctor. The DON stated this would be considered a change of treatment. The DON stated the doctor would need to be notified. The DON stated family was made aware of change of treatment when they visited the following day (2/10/2026) when they visited around lunch time. The DON stated the family had the right to know when there is a change in treatment The DON stated FM 1 should have been notified on 2/9/2026 when the order was discontinued. The DON stated if RP is not notified of change in treatment, there was a violation of the resident's and resident representative's right to know and make decisions for Resident 1.During a review of the facility's policy and procedure (P&P) titled, Change in a Resident's Condition or Status, last reviewed on 9/10/2025, the P&P indicated facility promptly notifies the resident, his or her attending physician, and the resident representative of changes in the resident's medical/mental condition and or status.1. The nurse will notify the resident's attending physician or physician on call when there has been a:e. need to alter the resident's medical (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056333 If continuation sheet Page 2 of 3 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 056333 B. Wing A. Building (X3) DATE SURVEY COMPLETED 02/18/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Mountain View Conv Hosp 13333 Fenton Avenue Sylmar, CA 91342 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 0580 Level of Harm - Minimal harm or potential for actual harm treatment significantly;During a review of the facility's P&P titled, Support Surface Guidelines, last reviewed on 9/10/2025, the P&P indicated use pressure ulcer risk scale such as the Braden Scale to help determine need for an appropriate type of pressure-relieving device. 1. Any individual at risk for developing pressure ulcers should be placed on a redistribution support surface, such as foam, static air, alternating air, gel, or air-loss device, when lying in bed. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056333 If continuation sheet Page 3 of 3