Inspection·January 29, 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, record review, and facility Policy and Procedure (P/P) the facility failed to accurately assess for a change in condition (CIC) for one of three sampled residents ( Resident 1) when a ssessment relevant to the change in condition to determine what nursing interventions are appropriate with the overall condition utilizing a physical assessment was done. This failure created a situation whereby the resident treatment and care were not recieved in accordance to medical needs. During review of Resident 1's admission Record (AR), dated 10/15/25, the AR indicated Resident 1 was initially admitted to the facility on [DATE], and then re-admitted on [DATE] with diagnoses that include hepatic encephalopathy (a decline in brain function occurring when a damaged liver cannot properly filter toxins), alcoholic cirrhosis of the liver without ascites (an advanced stage of alcohol-related liver disease where healthy liver tissue is replaced by scar tissue; the liver still performs basic functions without causing abdominal fluid buildup [ascites] or major complications), fluid overload (excessive water accumulates in the body's bloodstream and tissues), and acute respiratory failure with hypoxia (inability of the lungs to provide enough oxygen to the blood to preserve normal organ function).During review of Resident 1's weekly Advance Long Term Care Evaluations (ALTCE) dated 11/21/25, 12/3/25, 12/11/25, and 12/18/25 indicate the resident's abdomen was flat and non-tender. The ALTCE dated 11/26/25 indicates the abdomen was non-tender.During a review of Resident 1's Changes in Condition (CIC), dated 12/22/25 at 6:55 a.m., the CIC indicated Resident 1 had a sudden onset of chest congestion and low oxygen saturation (O2 sat - the amount of oxygen being carried by red blood cells in the body with a normal range of 95%-100%) trending around 75%. Question 4 of the CIC was marked yes on whether an abdominal/GI (gastrointestinal - relating to the stomach and the intestines). The follow-up question (4a) had multiple boxes to choose from such as abdominal pain, distended abdomen, or abdominal tenderness to describe the abdominal/GI changes. The only box selected was no changes observed. Review of records titled Progress Notes (PN) dated 12/22/26 indicated, the nursing observations, evaluation, and recommendations made were at around 6:45 a.m., resident had sudden onset of low O2 (Oxygen) trending around 75% and noted with chest congestion. Resident appearing anxious and having and dyspnea And further reviews did not show Resident 1's abdomen was assessed for change in condition prior to sending Resident 1 out to the ER (emergency) per resident request and recommendation by MD (physician).During review of Resident 1's hospital record, dated 12/23/25, the record indicates the resident was admitted to the hospital on [DATE] at 7:20 a.m., for acute shortness of breath. The hospital staff's physical examination revealed the resident had a painful abdomen and significant abdominal distention. Diagnostic imaging confirmed the resident had large volume ascites and laboratory results indicate 4600 mL (milliliters- measurement of volume) of ascites was removed via paracentesis (procedure where a needle is inserted through the abdominal wall into the space between the abdominal wall and organs to remove ascites).During a concurrent phone interview and record review on 2/4/26 at11:51 a.m. with Licensed Nurse (LN 2), Resident 1's CIC dated 12/22/25 was reviewed. LN 2 acknowledged Resident 1's abdomen was not assessed or evaluated for abdominal pain or distention.During a review of the facility's policies and procedures (P&P) titled, Change in Condition, dated 08/25/2022, the P&P indicates in part, The Licensed Nurse will assess the change of condition and determine what nursing interventions are appropriate. a. Before notifying the Physician/ APP (attending primary physician), the Licensed Nurse must observe and assess the overall condition utilizing a physical assessment and chart review. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056379 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 056379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oxnard Manor Healthcare Center 1400 West Gonzales Road Oxnard, CA 93036 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 0698 Provide safe, appropriate dialysis care/services for a resident who requires such services. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and Policy and Procedure (P/P)facility failed to ensure a resident receiving Hemodialysis ( (HD-procedure done by a trained professional to remove waste and excess fluids from the body when the kidneys stop working properly) received care and services consistent with professional standards of practice for one of three sampled residents (Resident 1)when:1. Pre and post dialysis evaluation was not completed2. A total inspection of an arteriovenous (AV) shunt (fistula, is a surgically created direct connection between an artery and a vein, typically in the arm, for long-term hemodialysis access) site area for color, warmth, redness, edema, and drainage was not done and documented. This failure resulted in Resident 1 developing a severe infection that required interventions. According to the American Nurses Association (ANA). (2021). Standards of practice. Nursing: Scope and Standards of Practice (3rd ed.) (pp. 53 - 66). First principle of documentation: 1. Documentation Characteristics: Accessible, Accurate and relevant, Auditable, Clear, concise, comprehensive, and thoughtful. Accuracy in nursing assessments is the collection of reliable and precise data that reflects the patient's true health status. During a review of Resident 1's admission Record (AR), dated 1/29/26 the AR indicated Resident 1 was admitted to the facility on [DATE] with diagnoses that included End Stage Renal Disease (ESRD - final stage of permanent kidney failure whereby requiring regular dialysis or a transplant for survival) and dependence on renal dialysis. During a review of Resident 1's Order Summary (OS) dated 2/12/25, the OS indicated Resident 1 had hemodialysis on Mondays, Wednesdays, and Fridays.During a review of Resident 1's OS dated for 1/29/2026 with a start order date of 3/24/24, the OS indicated, If bleeding occurs at AV shunt RUA (Right Upper Arm) any time after dialysis, apply pressure with clean gauze for 5-10 minutes.repeat until bleeding stops. If this intervention does not control the bleeding, notify MD.During a review of Resident 1's medical records titled, Pre-Dialysis Evaluation, B. Dialysis Unit to Complete, comments were written by the dialysis nurses on the access site assessment for the following dates of treatment:12/23/25 Dressing left on HD access.12/28/25 Dressing left on HD access since 12/26.must be removed to prevent clotting/damage to the access.1/5/26 Remove HD dressings tonight! Dressings from 12/26 were left on.1/12/26 Please remove fistula dressing 1 to 2 hours post HD to avoid problems with fistula site.1/16/26 Dressing left on from last treatment. Must be removed before bed.1/19/26 ‘Swabbed wound on access. Dressing left on since 1/16/26 and dressing damp left raw skin & sore.1/23/26 .Swabs done on access on 1/19 growth for staph aureus and pseudomonas aeruginosa (both bacteria that can cause an infection).During a review of Resident 1's medical records titled, Post Dialysis Evaluation, dated 12/23/25, 12/28/25, 1/5/26, 1/12/26, 1/16/26, and 1/23/26, there was no documentation to show dressings applied at the dialysis center after Resident 1's treatments were removed by the facility's receiving nurses.During a review of Resident 1's medical record titled Microbiology Report ( A report that help identify bacteria, fungi, or viruses from clinical specimens to diagnose infections and guide treatment) result date of 1/24/26 indicated, Culture Wound.Access Site.Collected 1/19/26.Organism Pseudomonas aeruginosa ( a major opportunistic pathogen, frequently causing severe, antibiotic-resistant), heavy growth and Staphylococcus aureus (a germ found on people's skin), moderate growth. In addition, the physician ordered Vancomycin and Ceftazidime (both antibiotics). During a review of Resident 1's Order Summary Report dated 1/21/26 the OS indicated Resident 1 had a physician appointment on 1/26/26 for possible infection R (right) upper AV shunt.During review of Resident 1's Care Plan (CP), dated 3/26/24, the CP indicated The resident needs hemodialysis related to End Stage Renal Disease. Nursing interventions included: Check and change dressing daily at access site. Document.Monitor/document/report PRN (as needed) Residents Affected - Few (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056379 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 056379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oxnard Manor Healthcare Center 1400 West Gonzales Road Oxnard, CA 93036 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 0698 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few any signs/symptoms (s/sx) of infection to access site: Redness, swelling, warmth, or drainage.Monitor /document/report PRN for s/sx of the following: Bleeding, hemorrhage, bacteremia, septic shock.During a review of Resident 1's medical record, there was no documentation to show Resident 1's dialysis access site had been monitored for infection since a growth result of bacteria was detected and was started on new antibiotic therapy.During a concurrent interview and record review on 1/29/26 at 1:46 p.m. with Licensed Nurse (LN 1), LN 1 stated being assigned familiar with Resident 1. LN 1 stated the process for post dialysis included entering notes in the medical record, if there were any, and to remove the dialysis dressing 1 hour after the resident arrives. LN1 acknowledged the Post Dialysis Evaluations dated 12/28/25, 1/7/26, 1/19/26, and 1/26/26 were signed by LN 1 and that there was no documentation to show the dressings applied at the dialysis center after Resident 1's treatments were removed.During a concurrent phone interview and record review on 2/3/26 at 3:34 p.m. with Licensed Nurse (LN 3), LN 3 confirmed to have been assigned and being familiar with Resident 1. Resident 1's pre-dialysis assessments dated 1/5/26, 1/19/26, and 1/26/26 were reviewed. LN 3 acknowledged the access site assessments performed by staff were discrepant from the dialysis center and that the resident's access site could not change so drastically during transport from the facility to dialysis. LN 3 stated the access site was assessed as being within normal limits (WNL) when there were other options in the electronic health record to better describe Resident 1's AVF site such as redness, swelling, pain, bleeding, or skin discoloration but those options were not selected. And LN 3 acknowledged, not to be aware the dressing on Resident 1's AVF site was the dressing from the previous dialysis session and confirmed there were no observations done to monitor for signs of inflammation, infection and or inspection of the shunt site area for color, warmth, redness, edema, and drainage.During a concurrent phone interview and record review on 2/3/26 at 4:03 p.m. with Licensed Nurse (LN 4), Resident 1's Pre-dialysis records dated 12/25 through 01/26 were reviewed. LN 4 confirmed to have been assigned and involved in the care of Resident 1 during when the resident had pre and post dialysis appointments. However, pre or post dialysis assessments were not performed on the days she was assigned to Resident 1 on 12/21/25, 12/28/25, 1/7/26, and 1/16/26, and 1/23/26 for Resident 1. Further interview with LN 4 revealed that dialysis dressing must be removed by the receiving nurse after 2 hours from arrival and LN 4 claimed to have assumed the dressings found on Resident 1's AVF site were for treatment provided by the facility. LN 4 state she was not aware the dressing on Resident 1's AVF site was the dressing from the previous dialysis session and acknowledged, there were no observations done to monitor for signs of inflammation, infection and or inspection of the shunt site area for color, warmth, redness, edema, and drainage,During a concurrent interview and record review on 2/19/26 at 10:21 a.m. with Director of Nursing (DON), Resident 1's Pre-dialysis records dated 12/25 through 01/26 were reviewed. DON confirmed the post dialysis dressing should be removed 4 - 6 hours after dialysis. DON confirmed dialysis center communicated to the facility on multiple occasions when Resident 1 had returned to dialysis with the dressing from the previous dialysis treatment and the risks it can cause to the AVF site.During a review of the facility's policies and procedures (P&P) titled, Dialysis Management, dated 3/24, the P&P indicated, The facility should assure that each resident receives care and services consistent with professional standards of practice. 3. A pre and post dialysis evaluation will be completed by the licensed nurse. 4. Vascular Access Site.b. Assessing, observing and documenting care of access sites daily, as applicable, such as.iii. Skin integrity (waxy skin, ulcerations, drainage from incisions) .vii. Evidence of infection at the surgical site, such as drainage, redness, tenderness at incision site, fever.During a review of the facility's P&P titled Arteriovenous Shunt Care, revised 01/12, indicated, . I. Observe for signs of inflammation, (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056379 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 056379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oxnard Manor Healthcare Center 1400 West Gonzales Road Oxnard, CA 93036 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 0698 infection and obstruction.Inspect total shunt site area for color, warmth, redness, edema and drainage, once per shift Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056379 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 056379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oxnard Manor Healthcare Center 1400 West Gonzales Road Oxnard, CA 93036 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 FORM CMS-2567 (02/99) Previous Versions Obsolete 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 interview and record review, the facility failed to ensure licensed nurses (LNs) were competent in providing quality of care for one of three sampled residents (Resident 1) when a comprehensive assessment and individualized care plan was not completed related to Resident 1's change of condition (new onset of infection).This failure had resulted in Resident 1's signs and symptoms of infection not monitored by staff and had the potential to develop complications. During a review of Resident 1's admission Record (AR), dated 1/29/26 the AR indicated Resident 1 was admitted to the facility on [DATE] with diagnoses that included End Stage Renal Disease (ESRD - final stage of permanent kidney failure whereby requiring regular dialysis or a transplant for survival) and dependence on renal dialysis (procedure done by a trained professional to remove waste and excess fluids from the body when the kidneys stop working properly). During a review of Resident 1's Order Summary (OS) dated 2/12/25, the OS indicated Resident 1 had hemodialysis on Mondays, Wednesdays, and Fridays. During a review of Resident 1's OS dated 3/24/24, the OS indicated, If bleeding occurs at AV shunt arteriovenous fistula (AVF- a surgical connection between an artery and a vein used for dialysis) RUA (Right Upper Arm) any time after dialysis, apply pressure with clean gauze for 5-10 minutes.repeat until bleeding stops. If this intervention does not control the bleeding, notify MD.During a review of Resident 1's medical record titled Microbiology Report (a report that help identify bacteria, fungi, or viruses from clinical specimens to diagnose infections and guide treatment) result date of 1/24/26 indicated, Culture Wound.Access Site.Collected 1/19/26.Organism Pseudomonas aeruginosa (a major opportunistic pathogen, frequently causing severe, antibiotic-resistant), heavy growth and Staphylococcus aureus (a germ found on people's skin), moderate growth. In addition, the physician ordered Vancomycin and Ceftazidime (both antibiotics). During a review of Resident 1's medical record, there was no documentation to show a comprehensive assessment and an individualized care plan with interventions was done for Resident 1's new onset of infection on the dialysis access site and that it had been monitored for signs and symptoms of infection/complication since the start of a new antibiotic therapy. In addition, there was no documentation on Resident 1's change of condition related to the infection. During a concurrent phone interview and record review on 2/3/26 at 2:19 p.m. with Licensed Nurse (LN 2), LN 2 confirmed there was no change of condition in the Resident 1's medical record for the positive growth result and antibiotic therapy. LN 2 stated a change of condition should have been initiated but was not. During a concurrent phone interview and record review on 2/3/26 at 3:34 p.m. with Licensed Nurse (LN 3), LN 3 confirmed to have been assigned and was familiar with Resident 1. LN 3 acknowledged that the receiving nurse did not initiate a change of condition when dialysis staff communicated that the resident had positive bacterial cultures and was receiving antibiotics. During a review of the facility's policy and procedure titled, Change in Condition, dated 08/22, indicated, .2. The Licensed Nurse will assess the change of condition and determine what nursing interventions are appropriate. a.i Notification to the Physician/APP will include a summary of the condition change and an assessment of the resident's vital signs and system review focusing on the condition and/or signs and symptoms for which the notification is required utilizing a SBAR format (situation, background, assessment, recommendation) .4. Reporting Information to the Physician/APP.b. Reporting Laboratory and Diagnostic results . Event ID: Facility ID: 056379 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 056379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oxnard Manor Healthcare Center 1400 West Gonzales Road Oxnard, CA 93036 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 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide or obtain laboratory tests/services when ordered and promptly tell the ordering practitioner of the results. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, record review, and facility Policy and Procedures (P/P) the facility failed to ensure that one of three sampled residents (Resident 1) received timely and appropriate medical care under the supervision of a licensed physician when laboratory results were communicated to the attending physician timely.This failure has the potential to delay/miss treatment and care for the residentDuring review of Resident 1's admission Record (AR), dated 10/15/25, the AR indicated Resident 1 was initially admitted to the facility on [DATE], and then re-admitted on [DATE] with diagnoses that include hepatic encephalopathy (a decline in brain function occurring when a damaged liver cannot properly filter toxins), alcoholic cirrhosis of the liver without ascites (an advanced stage of alcohol-related liver disease where healthy liver tissue is replaced by scar tissue; the liver still performs basic functions without causing abdominal fluid buildup (ascites) or major complications), fluid overload (excessive water accumulates in the body's bloodstream and tissues), and acute respiratory failure with hypoxia (inability of the lungs to provide enough oxygen to the blood to preserve normal organ function). During review of Resident 1's Progress Note (PN), dated 11/25/25 at 17:43, the PN indicates an order was received for an x-ray of sacrum/coccyx to evaluate for evidence of osteomyelitis (bacterial infection of the bone that causes inflammation, severe pain and swelling) and for laboratory testing of white blood count (WBC - blood cells that fight infection), sedimentation rate (ESRblood test that serves as an indicator of inflammation, infection, or cancer in the body), 25-hydroxy Vitamin D (measures Vitamin D levels stored in the body, which helps regulate calcium and phosphorus levels for bone health), comprehensive metabolic panel (CMP - blood test that measures different substances to evaluate organ function, metabolism, and electrolyte balance), C-reactive protein (CRP - measures protein levels produced by the liver, which rise significantly when there is inflammation, infection, or tissue damage in the body), and prealbumin (protein produced by the liver that transports thyroid hormones and Vitamin A; a rapid, sensitive marker for nutritional status and protein intake). Progress note dated 11/26/25 at 23:56 p.m. indicates a change of condition was initiated because the facility received a call from the lab to communicate that Resident 1 had a critical low calcium level of 6. The physician's recommendation was to continue to monitor. Further review of the progress notes showed no evidence that the x-ray of was reviewed by the attending physician. During review of Resident 1s PN dated 11/26/25 at 14:16 p.m. the PN indicates an order was received for a complete blood count with differential (CBC - blood test that measures the different type of blood cells to assess overall health), pro-time (PT - measures how many seconds it takes for the liquid portion [plasma] of blood to clot), International Normalized Ratio/partial thromboplastin time (INR/PTT - measure how long it takes for blood to clot), CMP, alpha-fetoprotein (AFP protein primarily produced by the liver that acts as a tumor marker in adults), ammonia (toxic waste product filtered by the liver; high levels indicate liver or kidney problems), antimitochondrial antibodies (AMA - test used to diagnose chronic liver disease or autoimmune disorder) and anti-smooth muscle antibody ([NAME] - a key marker for diagnosing autoimmune inflammation of the liver with high levels indicating the immune system is attacking liver cells). PN dated 11/28/25 at 19:09 p.m. indicates the results were sent to the physician. The physician recommendation was to increase the calcium supplement to be given twice a day versus once a day. Further review of the PN's indicate the laboratory results were faxed to the gastroenterologist on 12/1/25 at 18:58. A PN dated 12/2/25 at 8:34 a.m., indicates the facility received a call from the gastroenterologist requesting to transfer resident to the hospital for further evaluation related to the low hemoglobin (a protein inside red blood cells that (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 056379 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 056379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oxnard Manor Healthcare Center 1400 West Gonzales Road Oxnard, CA 93036 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 0773 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete transports oxygen from the lungs to the body's tissues and organs, while carrying carbon dioxide back to the lungs) level. PN dated 12/2/25 indicates the resident was transferred to the hospital at 14:45 p.m. and returned to the facility same day at around 21:15 p.m. with a diagnosis of hypocalcemia (low calcium). During review of Resident 1's PN dated 11/26/25 at 14:16 p.m. the PN indicates an abdominal ultrasound for liver cirrhosis was ordered on 11/26/25. Review of Resident 1's abdominal radiology report indicates findings of cholelithiasis (the presence of hardened deposits [gallstones] in the gallbladder) and mild ascites in the right upper area of the abdomen. Further review of the PN's showed no evidence that the attending physician was notified or had reviewed the ultrasound results. During review of Resident 1's PN dated 12/8/25, the PN indicates a laboratory test for CRP and ESR was ordered. Progress notes dated 12/8/25 and 12/10/25 indicate physician was notified of ESR and CRP results but were awaiting response back. Progress note dated 12/10/25 at 3:52 a.m. indicates no new order at this time per physician. During review of Resident 1's PN dated 12/10/25 a hemoglobin and hematocrit test (measures the percentage of total blood volume made up of red blood cells to assess oxygen carrying capacity) was ordered. Review of PN's showed no evidence the attending physician was notified or had reviewed the hemoglobin and hematocrit results which indicated the hematocrit level was 24.9 (normal range is 42.0 - 52.0) and a hemoglobin was 8.0 (normal range is 12.0 - 18.0). During review of Resident 1's PN dated 12/15/25, the PN indicates an order was placed to repeat the CRP and ESR. Further review of the PN's showed no evidence that the attending physician was notified or had reviewed the laboratory test results. The results indicated the CRP was abnormal at 12.05 with a reference range of 0.00-0.80. During a concurrent interview and review on 1/29/26 at 4:30 p.m. with the Director of Nursing (DON), Resident 1's laboratory results dated [DATE] were reviewed. The DON was asked for evidence indicating the physician had been notified of the test results. The DON provided a faxed coversheet with attached laboratory results of several residents at the facility. One of the laboratory results included the hemoglobin and hematocrit ordered on 12/10/25 for Resident 1. DON stated the fax was the only record available to show the physician had been notified of the lab results. The faxed cover sheet document has the date and time stamped indicating the time the records were faxed but it does not indicate or show the physician received the fax and reviewed the results. DON acknowledged there was no record to show receipt confirmation, or any follow-up with the physician to verify if there were any new orders.During a follow up interview on 1/29/26 at 4:59 p.m. with the DON, the DON was asked for physician notification of Resident 1's abdominal radiology report dated 11/26/25. DON stated that there were no records to show the physician was notified. During an interview on 2/12/26 at 3:42 p.m. with Medical Director (MD), MD acknowledged not recalling being informed about Resident 1's abnormal radiology and laboratory results. During review of the facility's policy and procedure (P&P) titled, Physician Services and Visits, dated 8/28/25, indicates Policy: The physician is responsible for evaluating, managing, and coordinating the resident's overall care in accordance with the resident's condition, applicable laws, and this facility's interdisciplinary approach to care. Purpose: To ensure that residents receive timely and appropriate medical care under the supervision of a licensed physician, in compliance with federal and state regulations. Event ID: Facility ID: 056379 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 056379 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/29/2026 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Oxnard Manor Healthcare Center 1400 West Gonzales Road Oxnard, CA 93036 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 Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure one of three sampled residents (Resident 1) had an accurate medical record when a diagnosis of decompensated liver cirrhosis with ascites (an advanced stage of liver scarring where the liver can no longer function properly, leading to significant complications, most notably the accumulation of fluid in the abdomen [ascites] causing abdominal distension, discomfort, and potential breathing issues) was not listed as a diagnosis on the admission record. This failure had the potential for Resident 1 not to receive adequate care and have unmet medical needs.According to ANA's (American Nurses' Association) book titled, Principles for Nursing Documentation (Guidance for Registered Nurses), copyright 2010, the guidance indicated, in part, Clear, accurate, and accessible documentation is an essential element of safe, quality, evidence-based nursing practice .to support the ability of the health care team to ensure informed decisions and high-quality care in the continuity of patient care. During review of Resident 1's admission Record (AR), dated 10/15/25, the AR indicated Resident 1 was initially admitted to the facility on [DATE], and then re-admitted on [DATE] with diagnoses that include hepatic encephalopathy (a decline in brain function occurring when a damaged liver cannot properly filter toxins) and alcoholic cirrhosis of the liver without ascites (an advanced stage of alcohol-related liver disease where healthy liver tissue is replaced by scar tissue; the liver still performs basic functions without causing abdominal fluid buildup (ascites) or major complications. During review of Resident 1's Hospital Discharge (HD), record dated 10/27/25, indicates Resident 1 had a past medical history of decompensated liver cirrhosis with ascites and fluid volume overload. Review of the AR dated 10/15/25 does not list the diagnosis of decompensated liver cirrhosis with ascites. Review of Resident 1's care plan also did not contain any nursing interventions for decompensated liver cirrhosis with ascites. During a concurrent interview and record review on 1/29/26 at 2:00 p.m. with Licensed Nurse 1 (LN 1), Resident 1's AR and HD records were reviewed. LN 1 acknowledged the diagnosis on the AR indicates alcoholic cirrhosis of liver without ascites and the HD record lists the diagnosis as decompensated cirrhosis with ascites. LN 1 stated that both diagnoses should be aligned to ensure appropriate care. During a concurrent interview and record review on 1/29/26 at 4:34 p.m. with Minimum Data Set Coordinator (MDS), Resident 1's AR was reviewed. MDS stated not knowing where the term without ascites was obtained that was entered in Resident 1's medical record for liver cirrhosis. MDS acknowledged the diagnosis of alcoholic cirrhosis of liver without ascites on the AR was incorrect. During an interview on 2/19/26 at 10:21 with DON, the DON acknowledged Resident 1's AR did not list the diagnosis of decompensated liver cirrhosis with ascites included in the medical records the facility received from the hospital prior to the resident's re-admission on [DATE]. Event ID: Facility ID: 056379 If continuation sheet Page 9 of 9